Value of endoscopic examination of airways and swallowing in tracheostomy decannulation

Abstract

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.

Aerodynamic measures of patients with tracheostomy capping before and after decannulation

“…Our findings highlight the importance of endoscopic airway assessment to exclude any airway obstruction before capping, which improves the clinician's confidence in decannulation decisions [9]. One of the recent systemic reviews recommended changing from the fixed protocolized approach of decannulation to a more flexible individualized approach for decannulation built on validated methods [22].…”

“…This cross-sectional study was conducted in the ENT department, Dubai hospital, in the period between February 2019 and January 2020. The study included sixteen adult patients with a tracheostomy who were fit for decannulation according to our institutional decannulation protocol [9]. Seven patients were due to prolonged mechanical ventilation, four patients were due to head and neck surgery, and five patients were due to cerebrovascular stroke.…”