We have located links that may give you full text access.
EVALUATION STUDY
JOURNAL ARTICLE
Clinical Criteria for Tracheostomy Decannulation in Subjects with Acquired Brain Injury.
Respiratory Care 2017 October
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 ≤5), blue dye test, number of trachea suctions, endoscopic assessment of airway patency (lumen diameter ≥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.
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 ≤5), blue dye test, number of trachea suctions, endoscopic assessment of airway patency (lumen diameter ≥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.
Full text links
Trending Papers
Acute and non-acute decompensation of liver cirrhosis (47/130).Liver International : Official Journal of the International Association for the Study of the Liver 2024 March 2
Guide to Utilization of the Microbiology Laboratory for Diagnosis of Infectious Diseases: 2024 Update by the Infectious Diseases Society of America (IDSA) and the American Society for Microbiology (ASM).Clinical Infectious Diseases 2024 March 6
Status epilepticus: what's new for the intensivist.Current Opinion in Critical Care 2024 Februrary 15
Administration of methylene blue in septic shock: pros and cons.Critical Care : the Official Journal of the Critical Care Forum 2024 Februrary 17
Get seemless 1-tap access through your institution/university
For the best experience, use the Read mobile app
All material on this website is protected by copyright, Copyright © 1994-2024 by WebMD LLC.
This website also contains material copyrighted by 3rd parties.
By using this service, you agree to our terms of use and privacy policy.
Your Privacy Choices
You can now claim free CME credits for this literature searchClaim now
Get seemless 1-tap access through your institution/university
For the best experience, use the Read mobile app