Clinical Criteria for Tracheostomy Decannulation in Subjects with Acquired Brain Injury.
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...
| Published in: | Respiratory Care Vol. 62; no. 10; pp. 1255 - 1264 |
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| Main Authors: | , , , , , , , , , , , |
| Format: | research tables/charts Journal Article |
| Published: |
Mary Ann Liebert, Inc.
Oct2017
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| Online Access: | View this record in EBSCOhost |
| fields | @attributes: recordID: 1 pdfLink: plink: https://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=125339110&site=ehost-live header: @attributes: shortDbName: ccm uiTerm: 125339110 longDbName: CINAHL Complete uiTag: AN controlInfo: bkinfo: dissinfo: jinfo: jid: 00201324 4GG jtl: Respiratory Care issn: 00201324 maglogo: N pubinfo: dt: Oct2017 vid: 62 iid: 10 pid: 1365 pub: Mary Ann Liebert, Inc. place: New Rochelle, New York artinfo: ui: 125339110 125339110 125339110 10.4187/respcare.05470 125339110 ppf: 1255 ppct: 9 formats: fmt: @attributes: type: P tig: atl: Clinical Criteria for Tracheostomy Decannulation in Subjects with Acquired Brain Injury. aug: au: Enrichi, Claudia Battel, Irene Zanetti, Cristiano Koch, Isabella Ventura, Laura Palmer, Katie Meneghello, Francesca Piccione, Francesco Rossi, Simonetta Lazzeri, Marta Sommariva, Maurizio Turolla, Andrea affil: Fondazione Ospedale di Neurori-abilitazione, Istituto di Ricovero e Cura a Carattere Scientifico, San Camillo, Venice, Italy sug: subj: Brain Injuries Therapy Tracheostomy Ventilator Weaning Decision Making, Clinical Protocols Cough Spirometry Glasgow Coma Scale Clinical Assessment Tools Scales Endoscopy Cross Sectional Studies Sensitivity and Specificity Descriptive Statistics T-Tests Mann-Whitney U Test Predictive Value of Tests Logistic Regression Fisher's Exact Test ROC Curve Data Analysis Software P-Value Adult Middle Age Aged Female Male Human Adult: 19-44 years Middle Aged: 45-64 years Aged: 65+ years Female Male ab: 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. pubtype: Academic Journal doctype: research tables/charts Journal Article ougenre: Article language: English refInfo: holdings: @attributes: islocal: N |
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