Evaluation of Factors Determining Tracheostomy Decannulation Failure Rate in Adults: An Indian Perspective Descriptive Study

Abstract

Decannulation is an essential step in liberating tracheostomised patients from mechanical ventilation. This procedure is purely based on the clinician’s judgment and there is no universally accepted protocol to date for this vital procedure. This study aimed to describe decannulation practice and failure rates in patients with tracheostomy and to determine the factors associated with the outcome of tube removal. A prospective study was done on 50 patients (both sexes) who required a tracheostomy and cared for at Command Hospital Bangalore Center between January 2019 and April 2020. Data were analyzed using descriptive and inferential tests. Out of the 50 decannulation decisions, 7 patients experienced decannulation failures giving a failure rate of 14%. Out of the 7 decannulation failure cases, about 4 patients (10%) experienced difficulty in swallowing and 3 patients (2%) experienced stridor. There was no associated mortality. A decannulation failure of 14% was seen in this study in tracheostomised patients after prolonged mechanical ventilation. Various factors govern the success of tracheostomy decannulation procedures which occur during the first 24–48 h after decannulation. Lack of swallowing/secretions/cough management and the development of stridor were the commonest cause of decannulation failure in this study.

Site of Tracheostomy and Its Influence on The Surgical Outcome and Quality of Life After Tracheal Resection and Anastomosis in Patients with Tracheal Stenosis

“…The preoperative endoscopic assessment showed that the maximum number of patients had grade-III stenosis (grade III: IV ¼ 10:3) and that, infrastomally, 10 healthy rings were present (median of 10 with a range of [8][9][10][11][12][13][14]. The vocal cords were mobile in all the patients assessed.…”

“…9 In a study by Bishnoi et al, the factors affecting decannulation were lack of swallowing/secretions/cough management and the development of stridor. 10 Further research is necessary to determine the risk factors for the development of postintubation stenosis and to develop guidelines regarding the timing of tracheostomy in intubated patients. Moreover, future studies are needed to assess patient outcomes in terms of both subjective and objective parameters to provide surgeons with a comprehensive interpretation of the results of the surgery.…”

“…In this era of litigation, it is necessary that we have an evidence base to counsel patients regarding the surgery so that they have an adequate understanding as to the risks and benefits. 3,[9][10][11][12][13][14] Hence, it becomes imperative that we have evidencebased guidelines regarding patient selection and surgical outcomes so that both the patient and the surgeon have pragmatic expectations regarding the surgical outcome.…”

Tracheostomy healing time after decannulation

“…However, we observed recannulation in four of 28 subjects, exceeding 2-5% which is considered an acceptable recannulation rate [20]. A recent study including 50 patients demonstrated a similar rate [11]. The wide variation in failure rates may be due to a lack of agreement on the time-point for assessing failure [23].…”

“…Many patients require frequent wound care due to bandage blow off or accumulation of pulmonary secretions around the stoma site [ 10 ]. Hygiene challenges associated with airway secretion may increase the risk of airway infection and respiratory failure, and may therefore heighten the risk of relapse to ventilator therapy [ 8 , 11 , 12 ]. Simple suturing of the skin has not proven effective and even entails a risk of subcutaneous emphysema.…”