Clinical Criteria for Tracheostomy Decannulation in Subjects with Acquired Brain Injury

Autor: Cristiano Zanetti, Maurizio Sommariva, Katie Palmer, Andrea Turolla, Francesco Piccione, Francesca Meneghello, Laura Ventura, Isabella Koch, Claudia Enrichi, Irene Battel, Simonetta Rossi, Marta Lazzeri
Přispěvatelé: Enrichi C., Battel I., Zanetti C., Koch I., Ventura L., Palmer K., Meneghello F., Piccione F., Rossi S., Lazzeri M., Sommariva M., Turolla A.
Rok vydání: 2017
Předmět:
Male
Time Factors
medicine.medical_treatment
Reflex cough
Clinical prediction rule
Critical Care and Intensive Care Medicine
0302 clinical medicine
Tracheostomy
Decannulation protocol
Medicine
Airways patency
General Medicine
Dysphagia
Middle Aged
Reference Standards
Acquired brain injury
Female
medicine.symptom
Respiratory Insufficiency
Pulmonary and Respiratory Medicine
Adult
medicine.medical_specialty
Risk Assessment
Sensitivity and Specificity
03 medical and health sciences
Tracheostomy tube
Swallowing
Tracheostomy tube capping
Predictive Value of Tests
Humans
Glasgow Coma Scale
Device Removal
Aged
Mechanical ventilation
Blue dye test
business.industry
Endoscopy
medicine.disease
Weaning protocol
Cannula
Respiration
Artificial
Surgery
Deglutition
Cross-Sectional Studies
030228 respiratory system
Cough
Brain Injuries
Airway Extubation
business
Airway
Voluntary cough
030217 neurology & neurosurgery
Zdroj: Respiratory care. 62(10)
ISSN: 1943-3654
Popis: BACKGROUND: Patients with acquired brain injury (ABI) often require long periods of having a tracheostomy tube for airway protection and prolonged mechanical ventilation. It has been recognized that fast and safe decannulation improves outcomes and facilitates the recovery process. Nevertheless, few studies have provided evidence for decannulation criteria, despite the high prevalence of ABI subjects with tracheostomies. The aim of our study was to assess which clinical parameters are the best predictors for decannulation in subjects with ABI. METHODS: In this cross-sectional study, we recruited 74 consecutive ABI subjects (mean age 51.52 ± 16.76) with tracheostomy tubes. First, the subjects underwent the original decannulation assessment for cannula removal. Second, they underwent our experimental decannulation protocol. The experimental protocol included: voluntary cough (cough peak flow >160 L/min), reflex cough, tracheostomy tube capping (>72 h), swallowing instrumental assessment (penetration aspiration scale 50%), saturation (SpO2 >95%), and level of consciousness evaluation (Glasgow coma scale >8). The reference standard was clinical removal of the tracheostomy tube within 48 h. RESULTS: Parameters showing the highest values of sensitivity and specificity, respectively, were tracheostomy tube capping (80%, 100%), endoscopy assessment of airway patency (100%, 30%), swallowing instrumental assessment (85%, 96%), and the blue dye test (65%, 85%). All these were combined in a clinical cluster parameter, which had higher sensitivity (100%) and specificity (82%). CONCLUSION: These results suggest that the best clinical prediction rule for decannulation in acquired brain injury subjects is a combination of the following assessments: (1) tracheostomy tube capping, (2) endoscopic assessment of patency of airways, (3) swallowing instrumental assessment, and (4) blue dye test.
Databáze: OpenAIRE
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