Clinical Criteria for Tracheostomy Decannulation in Subjects with Acquired Brain Injury

Enrichi, Claudia; Battel, Irene; Zanetti, Cristiano; Koch, Isabella; Ventura, Laura; Palmer, Katie; Meneghello, Francesca; Piccione, Francesco; Rossi, Simonetta; Lazzeri, Marta; Sommariva, Maurizio; Turolla, Andrea

doi:10.4187/respcare.05470

Cited by 53 publications

(58 citation statements)

References 19 publications

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“…In addition, they evaluated other parameters such as voluntary cough, cough reflex, tracheal suction numbers, oxygen saturation, and the level of consciousness. 69,70 A systematic review evaluated predictors of successful decannulation and proposed a predictive score, the results of which are similar to the studies mentioned above. They divided the parameters into two groups: quantitative objectives and semiquantitative parameters.…”

Section: Decannulation Protocolmentioning

confidence: 82%

“…Enrichi et al, in a population of 74 patients with acquired brain injury, found that the criteria that showed the highest values of sensitivity and specificity for the prediction of successful decannulation were plugging the tracheostomy tube (80-100%), endoscopic airway patency evaluation (100-30%), swallowing assessment (85-96%), and blue dye test (65-85%). 69,70 All these criteria that were combined into a single clinical parameter had greater sensitivity (100%) than specificity (82%). In addition, they evaluated other parameters such as voluntary cough, cough reflex, tracheal suction numbers, oxygen saturation, and the level of consciousness.…”

Section: Decannulation Protocolmentioning

confidence: 99%

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Current Status of Indications, Timing, Management, Complications, and Outcomes of Tracheostomy in Traumatic Brain Injury Patients

Quiñones-Ossa

Durango-Espinosa

Padilla-Zambrano

et al. 2020

JNRP

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Tracheostomy is the commonest bedside surgical procedure performed on patients needing mechanical ventilation with traumatic brain injury (TBI). The researchers made an effort to organize a narrative review of the indications, timing, management, complications, and outcomes of tracheostomy in relation to neuronal and brain-injured patients following TBI. The study observations were collated from the published literature, namely original articles, book chapters, case series, randomized studies, systematic reviews, and review articles. Information sorting was restricted to tracheostomy and its association with TBI. Care was taken to review the correlation of tracheostomy with clinical correlates including indications, scheduling, interventions, prognosis, and complications of the patients suffering from mild, moderate and severe TBIs using Glasgow Coma Scale, Glasgow Outcome Scale, intraclass correlation coefficient, and other internationally acclaimed outcome scales. Tracheostomy is needed to overcome airway obstruction, prolonged respiratory failure and as indispensable component of mechanical ventilation due to diverse reasons in intensive care unit. Researchers are divided over early tracheostomy or late tracheostomy from days to weeks. The conventional classic surgical technique of tracheostomy has been superseded by percutaneous techniques by being less invasive with lesser complications, classified into early and late complications that may be life threatening. Additional studies have to be conducted to validate and streamline varied observations to frame evidence-based practice for successful weaning and decannulation. Tracheostomy is a safer option in critically ill TBI patients for which a universally accepted protocol for tracheostomy is needed that can help to optimize indications and outcomes.

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Section: Decannulation Protocolmentioning

confidence: 82%

Section: Decannulation Protocolmentioning

confidence: 99%

Current Status of Indications, Timing, Management, Complications, and Outcomes of Tracheostomy in Traumatic Brain Injury Patients

Quiñones-Ossa

Durango-Espinosa

Padilla-Zambrano

et al. 2020

JNRP

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“…, Speed and Harding ) there are no studies that specifically relate to the tracheostomy management of patients in PDOC although recent evidence suggests that level of consciousness may not be a factor that predicts the ability to wean (Enrichi et al . , Perin et al . ).…”

Section: Introductionmentioning

confidence: 99%

Speech and language therapy best practice for patients in prolonged disorders of consciousness: a modified Delphi study

Roberts

Greenwood

2019

Intl J Lang & Comm Disor

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Background: Research regarding speech and language therapy (SLT) for patients in prolonged disorders of consciousness (PDOC) is very limited. The Royal College of Physicians' (RCP) PDOC guideline provides recommendations regarding best practice, but does not give detail about many aspects of assessment and management. As a result, SLTs have little information regarding best practice for this complex patient group. Aims: To ascertain the degree of consensus amongst expert SLTs regarding SLT best practice for patients in PDOC in order to inform the future development of SLT guidelines. Methods & Procedures:A two-round modified Delphi technique was used. Participants were recruited from major trauma centres and neurorehabilitation units in England and national SLT clinical excellence networks. To participate, SLTs had to be working on neurosciences, neurosurgery or neurorehabilitation wards that treat adult PDOC patients, or have ࣙ 3 years' experience of working with PDOC. The Round 1 questionnaire was developed from the RCP's PDOC guideline and from existing research literature. It included ratings of statements regarding SLT best practice using Likert or temporal scales, with optional written justifications/comments and opportunities for participants to suggest additional statements. The percentage agreement amongst participants was calculated for each Round 1 statement. Written justifications for views were analysed using content analysis. The Round 2 questionnaire contained both quantitative and qualitative feedback from Round 1, allowing participants to reappraise their views. The final degree of consensus was then calculated after completion of both rounds. Outcomes & Results: A total of 40 SLTs completed Round 1, with 36 completing Round 2 (90% response rate). Consensus was achieved for 87% (67/77) of statements regarding best practice on a variety of topics including communication, tracheostomy, dysphagia and oral hypersensitivity. The statements represented assessment, management and service delivery components of SLT practice. Conclusions & Implications: A total of 67 best practice statements were created. The statements provide a useful starting point for the creation of SLT guidelines to support best practice, and also have the potential to be used to advocate for the provision of SLT services for patients in PDOC. Future studies should focus on whether the expert opinion generated here can be borne out in experimental research.

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“…1,2,3 Sabe-se que a permanência prolongada do tubo orotraqueal é fator causador de complicações anatomofisiológicas laringotraqueais e potencial gerador de sequelas graves em via aérea. 4 As alterações laríngeas agudas são diagnósticas em até 94% dos pacientes, desde um processo inflamatório traqueal à estenose complexa. O mecanismo fisiopatológico conhecido dá-se secundário a isquemia promovida a membrana traqueal pelas altas pressões do cuff.…”

Section: Introductionunclassified

“…2,7,8 A cânula de traqueostomia, no entanto, apresenta-se como corpo estranho e pode causar complicações tais como broncorreia excessiva ou tosse; alteração do mecanismo fisiológico de proteção contra a broncoaspiração; diminuição da eficácia da tosse ; infecção; sangramento; dificuldade de vocalização, o que, além de provocar alterações laríngeas como hipotonia, contribui para o isolamento social do paciente. 4,9,10 Em pacientes que utilizam cânula de traqueostomia, a alteração do processo fisiológico impedindo que o ar não passe pela cavidade nasofaríngea entrando diretamente a árvore traqueobrônquica prejudica todo sistema de umidificação do ar. Secundário ao déficit de umidificação, o epitélio traqueal é envolvido em um progressivo processo inflamatório resultando em metaplasia escamosa e, consequentemente, comprometimento da função ciliar aumentando o risco de infecção respiratória.…”

Section: Introductionunclassified

Laringotraqueoscopia Flexível Na Decanulação De Pacientes Traqueostomizados: Otimização De Segurança Para O Paciente

Lemos

Bandeira²,

Marques³

et al. 2019

SaudPesq

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Avaliar a decanulação utilizando a laringotraqueoscopia flexível visando o reconhecimento das lesões laringotraqueais não diagnosticadas quando utilizados somente critérios clínicos. Participaram do estudo 100 pacientes, com idade entre 18 e 80 anos, traqueostomizados, com indicação de decanulação que foram submetidos à oclusão da cânula por 03 minutos para avaliar fonação e ventilação seguido da realização do exame. Foi comparada a indicação de decanulação por critérios clínicos com o diagnóstico de lesões laringotraqueais reconhecidas após o término da laringotraqueoscopia flexível. Os critérios de Myer-Cotton foram utilizados como referencial para classificação de doença laringotraqueal. Resultados: 62 (62%) pacientes apresentaram critérios clínicos para decanulação, porém, com doença laringotraqueal identificada pela laringotraqueoscopia flexível. Dentre estes, oito (8%) considerados aptos à decanulação baseados nos critérios clínicos apresentaram contraindicação à retirada da cânula. Apenas 26 (26%) pacientes não apresentaram doença laringotraqueal; 11 (11%) não foram decanulados por não preencherem critérios clínicos e endoscópicos. A laringotraqueoscopia flexível reconheceu doença laringotraqueal nos pacientes que preenchiam critérios clínicos para retirada da cânula traqueal. Este exame como rotina na avaliação de pacientes preenchendo critérios de decanulação mostrou-se útil e seguro.

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Clinical Criteria for Tracheostomy Decannulation in Subjects with Acquired Brain Injury

Cited by 53 publications

References 19 publications

Current Status of Indications, Timing, Management, Complications, and Outcomes of Tracheostomy in Traumatic Brain Injury Patients

Current Status of Indications, Timing, Management, Complications, and Outcomes of Tracheostomy in Traumatic Brain Injury Patients

Speech and language therapy best practice for patients in prolonged disorders of consciousness: a modified Delphi study

Laringotraqueoscopia Flexível Na Decanulação De Pacientes Traqueostomizados: Otimização De Segurança Para O Paciente

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