The practice of tracheostomy decannulation—a systematic review

Abstract

Decannulation is an essential step towards liberating tracheostomized patients from mechanical ventilation. However, despite its perceived importance, there is no universally accepted protocol for this vital transition. Presence of an intact sensorium coordinated swallowing and protective coughing are often the minimum requirements for a successful decannulation. Objective criteria for each of these may help better the clinical judgement of decannulation. In this systematic review on decannulation, we focus attention to this important aspect of tracheostomy care.Electronic supplementary materialThe online version of this article (doi:10.1186/s40560-017-0234-z) contains supplementary material, which is available to authorized users.

Current Status of Indications, Timing, Management, Complications, and Outcomes of Tracheostomy in Traumatic Brain Injury Patients

“…71 It is important to remember that it is a hypothetical score and requires validation in daily practice. Two recent studies, a systematic review and a retrospective study, associated positive spontaneous cough in patients with TBI as a predictor of the success of decannulation, 72,73 a result that is consistent with the literature reviewed. In general, decannulation is more often individualized than protocol based.…”

Decanulação: indicadores sociodemográficos, clínicos e fonoaudiológicos preditivos de sucesso

“…Despite controversies, the Blue Dye test is recommended by some studies in the literature, and is a resource used in clinical practice (6,13,21) . In the present study, the Blue Dye test was performed in 141 patients at the time of decannulation, with predominance of negative results for pulmonary aspiration in the decannulated patients and positive results for pulmonary aspiration in the non-decannulated patients, demonstrating that this is an important criterion to be analyzed regarding success in decannulation, because it is directly and intrinsically associated with the quality of swallowing and the capacity to protect the lower airways (6,11,13,18) .…”

“…The mean and median ages observed in this study were lower in the decannulated than in the non-decannulated patients, with statistical relevance, suggesting a correlation between age and success in decannulation. Some studies have described the variables age and gender as secondary factors associated with success in decannulation (9,11,12) ; however, two studies have identified significant correlation between age and success in decannulation, with patients with more advanced ages showing greater risks of process failure (18,26) , because the older the patient, the greater the possibility of comorbidities, which may interfere with the tracheostomy weaning process in this population (25) .…”

“…Application of the Blue Dye test in tracheostomized patients is a procedure used by speech-language pathologists to assess the swallowing of saliva and food in different consistencies and volumes. This test detects the presence or absence of tracheal aspiration and facilitates identification of aspirated material in the lower airways; however, there is no consensus in the literature on the accuracy, performance, and standardization of this test (6,11,18) . Despite controversies, the Blue Dye test is recommended by some studies in the literature, and is a resource used in clinical practice (6,13,21) .…”

“…The following criteria are suggested for indication and success in decannulation: ability to tolerate cuff deflation for 24h (9,10) ; presence of respiratory muscle strength and resistance (11,12) ; effective cough with ability to remove lung secretions (7,(9)(10)(11)(13)(14)(15) ; voluntary and reflexive cough (7,10,11,13) ; intact upper airways (5,9,13,15) ; absence of glottic or subglottic stenosis (16,17) ; preserved swallowing capacity (7,9,(11)(12)(13)(15)(16)(17) ; performance of the Blue Dye test (6,11,13,18) ; absence of previous head and neck surgery (7,11) ; use of phonation valve (11,14) ; tolerance to tracheostomy occlusion, with or without need for oxygen therapy (9,11,12,15,17) ; stable oxygen saturation for longer than 24h after tube occlusion (7,(9)(10)(11)…”