Feasibility of a single-stage tracheostomy decannulation protocol with endoscopy in adult patients.

Autor: Cohen O; Department of Otolaryngology, Head and Neck Surgery, Kaplan Medical Center, Rehovot, Israel.; Hebrew University-Hadassah Medical School, Jerusalem, Israel., Tzelnick S; Department of Otolaryngology, Head and Neck Surgery, Kaplan Medical Center, Rehovot, Israel., Lahav Y; Department of Otolaryngology, Head and Neck Surgery, Kaplan Medical Center, Rehovot, Israel.; Hebrew University-Hadassah Medical School, Jerusalem, Israel., Stavi D; Intensive Care Unit, Kaplan Medical Center, Rehovot, Israel.; Hebrew University-Hadassah Medical School, Jerusalem, Israel., Shoffel-Havakuk H; Department of Otolaryngology, Head and Neck Surgery, Kaplan Medical Center, Rehovot, Israel.; Hebrew University-Hadassah Medical School, Jerusalem, Israel., Hain M; Department of Otolaryngology, Head and Neck Surgery, Kaplan Medical Center, Rehovot, Israel.; Hebrew University-Hadassah Medical School, Jerusalem, Israel., Halperin D; Department of Otolaryngology, Head and Neck Surgery, Kaplan Medical Center, Rehovot, Israel.; Hebrew University-Hadassah Medical School, Jerusalem, Israel., Adi N; Intensive Care Unit, Kaplan Medical Center, Rehovot, Israel.; Hebrew University-Hadassah Medical School, Jerusalem, Israel.
Jazyk: angličtina
Zdroj: The Laryngoscope [Laryngoscope] 2016 Sep; Vol. 126 (9), pp. 2057-62. Date of Electronic Publication: 2015 Nov 26.
DOI: 10.1002/lary.25800
Abstrakt: Objectives/hypothesis: Gradual decrease in tube size and tube capping are considered the standard of care for tracheostomy decannulation. Both of these actions result in increased airway resistance. Immediate decannulation may offer a more tolerable approach.
Objective: To assess the feasibility of immediate tracheostomy decannulation compared with the traditional decannulation methods.
Methods: This study is a single institute, case-control retrospective study of patients between the years 2009 to 2014. The study group included all patients who underwent immediate decannulation, whereas the control group comprised patients who underwent traditional staged decannulation. An immediate decannulation protocol included admission to the intensive care unit, a comprehensive evaluation, decannulation, 24 hours of monitoring, and observation until discharge.
Results: Twenty-nine patients were included in the study group and 20 in the control group. No significant statistical difference was found between the two groups in the patients' medical history and tracheostomy data, except for the Acute Physiology and Chronic Health Evaluation II score and duration of the deflated cuff, which were significantly higher in the control group. A significant difference was found in the complication rate between the groups. In the staged decannulation group, four patients failed decannulation and required reinsertion of the tracheostomy cannula, whereas there were no such failures in the immediate decannulation group. Hospitalization duration after decannulation of the study group patients was significantly shorter than that of the control group.
Conclusion: Immediate decannulation may offer a safe alternative for weaning from tracheostomy. It may also reduce the duration of the weaning process and hospitalization.
Level of Evidence: 3b Laryngoscope, 126:2057-2062, 2016.
(© 2015 The American Laryngological, Rhinological and Otological Society, Inc.)
Databáze: MEDLINE
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