Tracheostomy decannulation methods and procedures for assessing readiness for decannulation in adults

Kutsukutsa, John; Kuupiel, Desmond; Monori-Kiss, Anna; Rey-Puech, Paula Del; Mashamba-Thompson, Tivani P.

doi:10.1097/xeb.0000000000000166

Cited by 31 publications

(33 citation statements)

References 42 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…The decannulation process is complex and relies on the co-ordination of pharyngolaryngeal sensation, airway protection, and strength amongst other factors. Systematic reviews consistently identify clinical stability, neurological factors, secretion management, effective swallowing, strength of cough, and airway patency as important factors [ 20 – 22 ]. However, there are no robust prognostic factors and clinical guidelines are heavily based on expert opinion [ 20 ].…”

Section: Introductionmentioning

confidence: 99%

“…Systematic reviews consistently identify clinical stability, neurological factors, secretion management, effective swallowing, strength of cough, and airway patency as important factors [ 20 – 22 ]. However, there are no robust prognostic factors and clinical guidelines are heavily based on expert opinion [ 20 ]. Finally, decannulation studies have heterogeneous case-mixes with the limited studies available on primary respiratory failure highlighting this indication for tracheostomy as a negative prognostic factor of tracheostomy duration [ 22 ].…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Tracheostomy, ventilatory wean, and decannulation in COVID-19 patients

Tornari

Šurda

Takhar

et al. 2020

Eur Arch Otorhinolaryngol

View full text Add to dashboard Cite

Purpose COVID-19 patients requiring mechanical ventilation can overwhelm existing bed capacity. We aimed to better understand the factors that influence the trajectory of tracheostomy care in this population to facilitate capacity planning and improve outcomes. Methods We conducted an observational cohort study of patients in a high-volume centre in the worst-affected region of the UK including all patients that underwent tracheostomy for COVID-19 pneumonitis ventilatory wean from 1st March 2020 to 10th May 2020. The primary outcome was time from insertion to decannulation. The analysis utilised Cox regression to account for patients that are still progressing through their tracheostomy pathway. Results At the point of analysis, a median 21 days (IQR 15-28) post-tracheostomy and 39 days (IQR 32-45) post-intubation, 35/69 (57.4%) patients had been decannulated a median of 17 days (IQR 12-20.5) post-insertion. The overall median age was 55 (IQR 48-61) with a male-to-female ratio of 2:1. In Cox regression analysis, FiO 2 at tracheostomy ≥ 0.4 (HR 1.80; 95% CI 0.89-3.60; p = 0.048) and last pre-tracheostomy peak cough flow (HR 2.27; 95% CI 1.78-4.45; p = 0.001) were independent variables associated with prolonged time to decannulation. Conclusion Higher FiO 2 at tracheostomy and higher pre-tracheostomy peak cough flow are associated with increased delay in COVID-19 tracheostomy patient decannulation. These finding comprise the most comprehensive report of COVID-19 tracheostomy decannulation to date and will assist service planning for future peaks of this pandemic.

show abstract

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Tracheostomy, ventilatory wean, and decannulation in COVID-19 patients

Tornari

Šurda

Takhar

et al. 2020

Eur Arch Otorhinolaryngol

View full text Add to dashboard Cite

show abstract

“…As a patient begins to recover from the insult that led to ICU admission, there begins a process of rehabilitation that encompasses facilitating communication, swallowing, weaning and, ideally, eventual decannulation [25,26]. Collaboration across specialties is critical to deliver safe and effective care, and we are unified in commending the benefits of a multidisciplinary tracheostomy team who work together in synchronous ward rounds, with standardised protocols/guidelines, interdisciplinary education, patient and family involvement, and quality improvement processes [27].…”

Section: Basic Tracheostomy Carementioning

confidence: 99%

Tracheostomy care and decannulation during the COVID-19 pandemic. A multidisciplinary clinical practice guideline

Rovira

Dawson

Walker

et al. 2020

Eur Arch Otorhinolaryngol

View full text Add to dashboard Cite

Purpose Traditional critical care dogma regarding the benefits of early tracheostomy during invasive ventilation has had to be revisited due to the risk of COVID-19 to patients and healthcare staff. Standard practises that have evolved to minimise the risks associated with tracheostomy must be comprehensively reviewed in light of the numerous potential episodes for aerosol generating procedures. We meet the urgent need for safe practise standards by presenting the experience of two major London teaching hospitals, and synthesise our findings into an evidence-based guideline for multidisciplinary care of the tracheostomy patient. Methods This is a narrative review presenting the extensive experience of over 120 patients with tracheostomy, with a pragmatic analysis of currently available evidence for safe tracheostomy care in COVID-19 patients. Results Tracheostomy care involves many potentially aerosol generating procedures which may pose a risk of viral transmission to staff and patients. We make a series of recommendations to ameliorate this risk through infection control strategies, equipment modification, and individualised decannulation protocols. In addition, we discuss the multidisciplinary collaboration that is absolutely fundamental to safe and effective practise. Conclusion COVID-19 requires a radical rethink of many tenets of tracheostomy care, and controversy continues to exist regarding the optimal techniques to minimise risk to patients and healthcare workers. Safe practise requires a coordinated multidisciplinary team approach to infection control, weaning and decannulation, with integrated processes for continuous prospective data collection and audit.

show abstract

“…Little evidence is available to guide the weaning process and optimal timing of tracheostomy tube removal. No validated and standard guidelines are followed by the clinicians in the decannulation decision, and this process is left to expert opinion and institutional guidelines [3][4][5][6][7]. Decannulation decision is crucial because decannulation delay can delay rehabilitation, reduces patient comfort, and is associated with longer hospitalization, higher costs, and more tracheostomy complication.…”

Section: Introductionmentioning

confidence: 99%

“…Fiberoptic endoscopic evaluation of swallowing (FEES) has been proven to be a standardized dysphagia assessment tool, but its use in tracheostomy decannulation protocol with additional endoscopic subglottic and tracheal airway assessment is not firmly established in clinical practice and its use depend on clinical experience. Few studies were done to explore the role of endoscopic assessment in tracheostomy decannulation decision accuracy [5,9,15,16].…”

Section: Introductionmentioning

confidence: 99%

Value of endoscopic examination of airways and swallowing in tracheostomy decannulation

Youssef

Abdulla

2020

Egypt J Otolaryngol

View full text Add to dashboard Cite

Background: Tracheostomy decannulation decision is the major challenge in the clinical management of tracheostomy patients. Little evidence is available to guide the weaning process and optimal timing of tracheostomy tube removal. The purpose of the study was to investigate the value of endoscopic assessment in the tracheostomy decannulation decision. Results: The study included 154 tracheostomized adult patients. Bedside assessment was done for 112 patients, and the other 42 patients were deceased. The results of bedside assessment lead to successful decannulation in 18 patients (16%), while 94 patients (84%) were unfit for decannulation. The most common cause of unfitness was aspiration and poor swallowing in 41% of patients. The endoscopic assessment was done for 59 patients out of 94 patients that were unfit for decannulation; thirteen patients of them were fit for decannulation (22%). The final status of the patients before discharge was decannulated in 31 cases and 81 patients were discharged with a tracheostomy. Conclusions: The results indicated the importance of endoscopic assessment in the decannulation decision of tracheostomized patients. A large proportion of patients who are unfit for decannulation by bedside assessment could be fit after endoscopic assessment. Endoscopic assessment is essential particularly in tracheostomized patients who have failed to achieve decannulation through conventional protocols.

show abstract

Tracheostomy decannulation methods and procedures for assessing readiness for decannulation in adults

Cited by 31 publications

References 42 publications

Tracheostomy, ventilatory wean, and decannulation in COVID-19 patients

Tracheostomy, ventilatory wean, and decannulation in COVID-19 patients

Tracheostomy care and decannulation during the COVID-19 pandemic. A multidisciplinary clinical practice guideline

Value of endoscopic examination of airways and swallowing in tracheostomy decannulation

Contact Info

Product

Resources

About