The practice of tracheostomy decannulation-a systematic review

Ratender Kumar Singh, Sai Saran, Arvind K Baronia, Ratender Kumar Singh, Sai Saran, Arvind K Baronia

Abstract

Decannulation is an essential step towards liberating tracheostomized patients from mechanical ventilation. However, despite its perceived importance, there is no universally accepted protocol for this vital transition. Presence of an intact sensorium coordinated swallowing and protective coughing are often the minimum requirements for a successful decannulation. Objective criteria for each of these may help better the clinical judgement of decannulation. In this systematic review on decannulation, we focus attention to this important aspect of tracheostomy care.

Keywords: Decannulation; Tracheostomy; Weaning.

Figures

Fig. 1
Fig. 1
Flow diagram of selection of studies
Fig. 2
Fig. 2
Decannulation algorithm

References

    1. Esteban A, Anzueto A, Alía I, Gordo F, Apezteguía C, Pálizas F, et al. How is mechanical ventilation employed in the intensive care unit? An international utilization review. Am J Respir Crit Care Med. 2000;161(5):1450–8. doi: 10.1164/ajrccm.161.5.9902018.
    1. Garuti G, Reverberi C, Briganti A, Massobrio M, Lombardi F, Lusuardi M. Swallowing disorders in tracheostomised patients: a multidisciplinary/multiprofessional approach in decannulation protocols. Multidiscip Respir Med. 2014;9(1):36. doi: 10.1186/2049-6958-9-36.
    1. Schmidt U, Hess D, Bittner E. To decannulate or not to decannulate: a combination of readiness for the floor and floor readiness? Crit Care Med. 2011;39(10):2360–1. doi: 10.1097/CCM.0b013e318226618a.
    1. O ’connor HH, Kirby Ctr KJ, Terrin N, Hill NS, White AC. Decannulation following tracheostomy for prolonged mechanical ventilation. J Intensive Care Med. 2009;24(3):187–94. doi: 10.1177/0885066609332701.
    1. Heffner JE, Hess D. Tracheostomy management in the chronically ventilated patient. Clin Chest Med. 2001;22(1):55–69. doi: 10.1016/S0272-5231(05)70025-3.
    1. Martinez GH, Fernandez R, Casado MS, Cuena R, Lopez-Reina P, Zamora S, et al. Tracheostomy tube in place at intensive care unit discharge is associated with increased ward mortality. Respir Care. 2009;54(12):1644–52.
    1. Fernandez R, Bacelar N, Hernandez G, Tubau I, Baigorri F, Gili G, et al. Ward mortality in patients discharged from the ICU with tracheostomy may depend on patient’s vulnerability. Intensive Care Med. 2008;34(10):1878–82. doi: 10.1007/s00134-008-1169-6.
    1. Ceriana P, Carlucci A, Navalesi P, Rampulla C, Delmastro M, Piaggi G, et al. Weaning from tracheotomy in long-term mechanically ventilated patients: feasibility of a decisional flowchart and clinical outcome. Intensive Care Med. 2003;29(5):845–8. doi: 10.1007/s00134-003-1689-z.
    1. Shrestha KK, Mohindra S, Mohindra S. How to decannulate tracheostomised severe head trauma patients: a comparison of gradual vs abrupt technique. Nepal Med Coll J. 2012;14(3):207–11.
    1. Jarde A, Losilla J, Vives J, Rodrigo MF. Q-Coh: a tool to screen the methodological quality of cohort studies in systematic reviews and meta-analyses. Int J Clin Heal Psychol. 2013;13:138–46. doi: 10.1016/S1697-2600(13)70017-6.
    1. Rumbak MJ, Graves AE, Scott MP, Sporn GK, Walsh FW, Anderson WM, Goldman AL. Tracheostomy tube occlusion protoc predict success tracheal decannulation follow long term mech vent. Crit Care Med. 1997;25(3):413–7. doi: 10.1097/00003246-199703000-00007.
    1. Bach JR, Saporito LR. Criteria for extubation and tracheostomy tube removal for patients with ventilatory failure: a different approach to weaning. Chest. 1996;110(6):1566–71. doi: 10.1378/chest.110.6.1566.
    1. Tobin AE, Santamaria JD. An intensivist-led tracheostomy review team is associated with shorter decannulation time and length of stay: a prospective cohort study. Crit Care. 2008;12(2):R48. doi: 10.1186/cc6864.
    1. Choate K, Barbetti J, Currey J. Tracheostomy decannulation failure rate following critical illness: a prospective descriptive study. Aust Crit Care. 2009;22(1):8–15. doi: 10.1016/j.aucc.2008.10.002.
    1. Chan LYY, Jones AYM, Chung RCK, Hung KN. Peak flow rate during induced cough: a predictor of successful decannulation of a tracheotomy tube in neurosurgical patients. Am J Crit Care. 2010;19(3):278–84. doi: 10.4037/ajcc2009575.
    1. Warnecke T, Suntrup S, Teismann IK, Hamacher C, Oelenberg S, Dziewas R. Standardized endoscopic swallowing evaluation for tracheostomy decannulation in critically ill neurologic patients. Crit Care Med. 2013;41(7):1728–32. doi: 10.1097/CCM.0b013e31828a4626.
    1. Pandian V, Miller CR, Schiavi AJ, Yarmus L, Contractor A, Haut ER, et al. Utilization of a standardized tracheostomy capping and decannulation protocol to improve patient safety. Laryngoscope. 2014;124(8):1794–800. doi: 10.1002/lary.24625.
    1. Guerlain J, Guerrero JAS, Baujat B, St Guily JL, Périé S. Peak inspiratory flow is a simple means of predicting decannulation success following head and neck cancer surgery: a prospective study of fifty-six patients. Laryngoscope. 2015;125(2):365–70. doi: 10.1002/lary.24904.
    1. Leung R, MacGregor L, Campbell D, Berkowitz RG. Decannulation and survival following tracheostomy in an intensive care unit. Ann Otol Rhinol Laryngol. 2003;112(10):853–8. doi: 10.1177/000348940311201005.
    1. Budweiser S, Baur T, Jörres RA, Kollert F, Pfeifer M, Heinemann F. Predictors of successful decannulation using a tracheostomy retainer in patients with prolonged weaning and persisting respiratory failure. Respiration. 2012;84(6):469–76. doi: 10.1159/000335740.
    1. Byrd JK, Ranasinghe VJ, Day KE, Wolf BJ, Lentsch EJ. Predictors of clinical outcome after tracheotomy in critically ill obese patients. Laryngoscope. 2014;124(5):1118–22. doi: 10.1002/lary.24347.
    1. Pasqua F, Nardi I, Provenzano A, Mari A. Weaning from tracheostomy in subjects undergoing pulmonary rehabilitation. Multidiscip Respir Med. 2015;10(11):35. doi: 10.1186/s40248-015-0032-1.
    1. Cohen O, Tzelnick S, Lahav Y, Stavi D, Shoffel-Havakuk H, Hain M, et al. Feasibility of a single-stage tracheostomy decannulation protocol with endoscopy in adult patients. Laryngoscope. 2016;126(9):2057–62. doi: 10.1002/lary.25800.
    1. Stelfox HT, Crimi C, Berra L, Noto A, Schmidt U, Bigatello LM, et al. Determinants of tracheostomy decannulation: an international survey. Crit Care. 2008;12(1):R26. doi: 10.1186/cc6802.
    1. Marchese S, Corrado A, Scala R, Corrao S, Ambrosino N. Tracheostomy in patients with long-term mechanical ventilation: a survey. Respir Med. 2010;104(5):749–53. doi: 10.1016/j.rmed.2010.01.003.
    1. Santus P, Gramegna A, Radovanovic D, Raccanelli R, Valenti V, Rabbiosi D, et al. A systematic review on tracheostomy decannulation: a proposal of a quantitative semiquantitative clinical score. BMC Pulm Med. 2014;14:201. doi: 10.1186/1471-2466-14-201.

Source: PubMed

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