Pre-decannulation Peristomal Findings in Tracheostomized Cases and Their Effect on the Success of Decannulation

Abstract

Decannulating a patient on a tracheostomy is a procedure that has to be dealt with vigilantly. This study evaluated both external and telescopic/bronchoscopic findings at the peristomal level of subjects being considered for decannulation. The patients did not undergo any intervention after above observations and before attempting decannulation. Thereafter peristomal findings and their contribution towards failure to decannulate were correlated. Thirty subjects were studied prospectively, of whom 21 (70 %) demonstrated peristomal complications including granulation tissue, ulceration, mucopurulent discharge, suprastomal granulations, suprastomal collapse and suprastomal flap. Complications were more common in the younger age group (p = 0.007) as well as in tracheostomies of longer duration with mean duration [20 months (p = 0.045). However there was no statistically significant correlation between the success of decannulation and various peristomal findings. Therefore the success of decannulation in a particular case cannot always be correctly predicted by peristomal assessment.

Critérios para decanulação da traqueostomia: revisão de literatura

“…We also found that 14 articles used objective examinations in the decannulation process, having five studies using nasolaringofibroscopia (11,18,20,22,31) , four using broncoscopia (20,27,28,35) , two using tomography (18,36) and three studies using swallowing videoendoscopy (15,18,26) . The use of the pulmonar (29) and manometry (31) function tests were less observed.…”

“…Three of the studies used medical records as a way of collecting data, and one study did not mention the members of the team. Luo et al (24) 44.57 4 17 X Berney et al (25) 47 15 29 X X X X Pandian et al (20) 58.07 18 39 X X X X Warnecke et al (26) 56.4 45 55 X X Hernández et al (27) 54.5 43 108 X X X Pryor et al (15) 53 44 82 X X X Cohen et al (22) 61.6 18 31 X X Mah et al (19) 55.1 144 249 X X X Zanata et al (9) 32.1 10 50 X Mathur et al (28) 22.67 12 18 X Kim et al (29) 47.6 7 55 ----Mitton et al (30) 52 41 65 X X X X Welton et al (16) 61 23 21 X X X X Pasqua et al (31) 64 21 27 ----Zanata et al (21) 53 4 16 X X Thomas et al (17) 71.4 36 86 X X X Tawfik et al (32) 48 57 38 ----Nakashima et al (33) 44.9 22 142 X Terra et al (34) 37.8 33 59 X X Schneider et al (35) 61.4 22 31 X X X Bianchi et al (11) 75 24 27 X X X Shrestha et al (36) 36 20 98 X X X -Budweiser et al (37) 70 46 120 ----Gundogdu et al (18) 29. Baseline disturbances data were also listed in the populations of each article (Table 2).…”

“…Among the steps of the decannulation process, this literature review found procedures of cuff deflation; occlusion training, replacement of tracheostomy cannula, cough training, mobilization of secretion, assessment of airway permeability and swallowing and use of speech valve in most of the articles (Table 3). Six articles did not describe the protocol used for decannulation (15,17,28,29,32,34) .…”

“…The factors that led to failure in the decannulation process were difficulty in expectorating or increased secretion, presence of tracheal stenosis and pulmonary infection, and these three factors were the most present in the studies (Chart 1). Luo et al (24) X Berney et al (25) X X Pandian et al (20) X X X X X Warnecke et al (26) X Hernández et al (27) X X X X X Pryor et al (15) X X X X X X X Cohen et al (22) - (19) X X X X X Zanata et al (9) X Mathur et al (28) ------------Kim et al (29) X Mitton et al (30) X Welton et al (16) X Pasqua et al (31) X X X Zanata et al (21) X Thomas et al (17) X X Tawfik et al (32) X X Nakashima et al (33) X Terra et al (34) X Schneider et al (35) X Bianchi et al (11) X X X Shrestha et al (36) X Budweiser et al (37) X X Gundogdu et al (18) X Berney et al (25) 24.65 9.9…”

“…Tawfik et al (32) 31 -Nakashima et al (33) 61. Warnecke et al (26) X X Hernández et al (27) X X X X X X Pryor et al (15) X X Cohen et al (22) X X Mah et al (19) X X X Zanata et al (9) X X X Mathur et al (28) --------Kim et al (29) X X Mitton et al (30) X Welton et al (16) X X X X X Pasqua et al (31) X X X X X X Zanata et al (21) X X X X X X Thomas et al (17) ---X ----Tawfik et al (32) --------Nakashima et al (33) X X X Terra et al (34) --------Schneider et al (35) X X X Bianchi et al (11) X X X X X Shrestha et al (36) X X X Budweiser et al (37) X X X Gundogdu et al (18) X…”