Weaning from tracheostomy in subjects undergoing pulmonary rehabilitation

Pasqua, Franco; Nardi, Ilaria; Provenzano, Alessia; Mari, A.

doi:10.4081/mrm.2015.342

Cited by 3 publications

(16 citation statements)

References 24 publications

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“…20 Exact timing to perform tracheostomy procedure among intubated patients is the most debated aspect of tracheostomy. 16,21,22 In our study mean days of intubation before tracheostomy was 7 days. A meta-analysis by Adly et al, shows that in patients with prolonged intubation, tracheostomy done within 7 days of intubation significantly reduces the incidence of mortality and duration on mechanical ventilation.…”

Section: Discussionmentioning

confidence: 49%

Retrospective clinical study of tracheostomy among intubated patients of respiratory intensive care unit

Rao

Bipinkumar

2020

Int J Otorhinolaryngol Head Neck Surg

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Background: Tracheostomy is a common surgical procedure performed in upper airway obstruction to establish alternate airway, to ease the access for secretion removal and protect lower airways and to wean in critically ill, ventilator-dependent patients. This retrospective clinical study emphasises on the indications and clinical outcome of tracheostomy procedure among intubated patients of varied clinical diagnosis in respiratory intensive care unit (RICU).Methods: This is a retrospective clinical study of intubated patients of RICU who underwent tracheostomy between Jan 2014 to Dec 2019.The case sheets of patients who fulfilled the inclusion criteria of this study and whose records were available in medical records department (MRD) of our institute for the study period were analysed for the indications for tracheostomy, timing of tracheostomy and its clinical outcome among them.Results: A total of 33 patients were included in this study and their case sheets were analysed. Most common indication for the tracheostomy was found to be prolonged intubation secondary to the chemical poisoning. The mean days of intubation before the tracheostomy was 7 days. The mean days of stay in RICU after tracheostomy among survived and dead patients was 21 and 7 days respectively which was highly significant (p=0.00).Conclusion: This retrospective study concludes that conditional survival after the tracheostomy among the previously intubated patients is found to be more after three weeks whereas the mortality is likely to be in the first week of post tracheostomy period. Hence the number of days of stay after the tracheostomy among these patients, there need not be a linear decrease in survival and should not be the reason for being despondent.

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Section: Discussionmentioning

confidence: 49%

Retrospective clinical study of tracheostomy among intubated patients of respiratory intensive care unit

Rao

Bipinkumar

2020

Int J Otorhinolaryngol Head Neck Surg

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“…We also found that 14 articles used objective examinations in the decannulation process, having five studies using nasolaringofibroscopia (11,18,20,22,31) , four using broncoscopia (20,27,28,35) , two using tomography (18,36) and three studies using swallowing videoendoscopy (15,18,26) . The use of the pulmonar (29) and manometry (31) function tests were less observed.…”

Section: Resultsmentioning

confidence: 83%

“…Three of the studies used medical records as a way of collecting data, and one study did not mention the members of the team. Luo et al (24) 44.57 4 17 X Berney et al (25) 47 15 29 X X X X Pandian et al (20) 58.07 18 39 X X X X Warnecke et al (26) 56.4 45 55 X X Hernández et al (27) 54.5 43 108 X X X Pryor et al (15) 53 44 82 X X X Cohen et al (22) 61.6 18 31 X X Mah et al (19) 55.1 144 249 X X X Zanata et al (9) 32.1 10 50 X Mathur et al (28) 22.67 12 18 X Kim et al (29) 47.6 7 55 ----Mitton et al (30) 52 41 65 X X X X Welton et al (16) 61 23 21 X X X X Pasqua et al (31) 64 21 27 ----Zanata et al (21) 53 4 16 X X Thomas et al (17) 71.4 36 86 X X X Tawfik et al (32) 48 57 38 ----Nakashima et al (33) 44.9 22 142 X Terra et al (34) 37.8 33 59 X X Schneider et al (35) 61.4 22 31 X X X Bianchi et al (11) 75 24 27 X X X Shrestha et al (36) 36 20 98 X X X -Budweiser et al (37) 70 46 120 ----Gundogdu et al (18) 29. Baseline disturbances data were also listed in the populations of each article (Table 2).…”

Section: Resultsmentioning

confidence: 99%

“…The factors that led to failure in the decannulation process were difficulty in expectorating or increased secretion, presence of tracheal stenosis and pulmonary infection, and these three factors were the most present in the studies (Chart 1). Luo et al (24) X Berney et al (25) X X Pandian et al (20) X X X X X Warnecke et al (26) X Hernández et al (27) X X X X X Pryor et al (15) X X X X X X X Cohen et al (22) - (19) X X X X X Zanata et al (9) X Mathur et al (28) ------------Kim et al (29) X Mitton et al (30) X Welton et al (16) X Pasqua et al (31) X X X Zanata et al (21) X Thomas et al (17) X X Tawfik et al (32) X X Nakashima et al (33) X Terra et al (34) X Schneider et al (35) X Bianchi et al (11) X X X Shrestha et al (36) X Budweiser et al (37) X X Gundogdu et al (18) X Berney et al (25) 24.65 9.9…”

Section: Resultsmentioning

confidence: 99%

“…Tawfik et al (32) 31 -Nakashima et al (33) 61. Warnecke et al (26) X X Hernández et al (27) X X X X X X Pryor et al (15) X X Cohen et al (22) X X Mah et al (19) X X X Zanata et al (9) X X X Mathur et al (28) --------Kim et al (29) X X Mitton et al (30) X Welton et al (16) X X X X X Pasqua et al (31) X X X X X X Zanata et al (21) X X X X X X Thomas et al (17) ---X ----Tawfik et al (32) --------Nakashima et al (33) X X X Terra et al (34) --------Schneider et al (35) X X X Bianchi et al (11) X X X X X Shrestha et al (36) X X X Budweiser et al (37) X X X Gundogdu et al (18) X…”

Section: Resultsmentioning

confidence: 99%

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Critérios para decanulação da traqueostomia: revisão de literatura

Medeiros

Sassi

Lirani-Silva

et al. 2019

CoDAS

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RESUMO Objetivo Realizar um levantamento bibliográfico a respeito da decanulação da traqueostomia para verificar os fatores e protocolos utilizados em estudos internacionais. Estratégia de pesquisa Estudo de revisão de literatura utilizando a base de dados PubMed com os descritores em língua inglesa “Tracheostomy”, “Weaning”, “Decannulation”, “Removal tube”, “Speech, Language and Hearing Sciences”, “Intensive Care Units”, “Dysphagia”, “Swallowing”, “Deglutition” e “Deglutition Disorders”. Critérios de seleção Estudos publicados nos últimos cinco anos (2012 a 2017), com população acima de 18 anos de idade; pesquisas realizadas somente com seres humanos; artigos publicados em língua inglesa; artigos com acesso completo irrestrito; pesquisas relacionadas aos objetivos do estudo. Análise dos dados foram analisados quanto aos seguintes itens: caracterização da amostra; profissionais envolvidos no processo da decanulação; etapas do processo de decanulação; tempo total em dias de uso da traqueostomia; tempo total em dias para concluir processo de decanulação; fatores de insucesso para conclusão do processo de decanulação. Resultados A maior parte da população estudada foi do gênero masculino e com alterações neurológicas. Dos profissionais envolvidos no processo de decanulação, participaram em ordem decrescente médicos, fonoaudiólogos, fisioterapeutas e enfermeiros. As etapas da decanulação mais citadas foram: avaliação da deglutição; treino de oclusão; avaliação da permeabilidade de passagem do ar; habilidade de manipulação de secreção e troca de cânula; desinsuflação do cuff e treino de tosse; uso de válvula de fala. Além disso, obtiveram-se dados a respeito do tempo total de traqueostomia e de decanulação. Conclusão A presença do fonoaudiólogo é extremamente importante no processo de decanulação, visto que a avaliação da deglutição foi a etapa mais citada nos estudos, sendo esse trabalho realizado em conjunto com médicos e fisioterapeutas.

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Incidence, causes, and predictors of unsuccessful decannulation following prolonged weaning

Ghiani

Τσίτουρας

Paderewska

et al. 2022

Therapeutic Advances in Chronic Disease

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Background: Liberation from prolonged tracheostomy ventilation involves ventilator weaning and removal of the tracheal cannula (referred to as decannulation). This study evaluated the incidence, causes, and predictors of unsuccessful decannulation following prolonged weaning. Methods: Observational retrospective cohort study of 532 prolonged mechanically ventilated, tracheotomized patients treated at a specialized weaning center between June 2013 and January 2021. We summarized the causes for unsuccessful decannulations and used a binary logistic regression analysis to derive and validate associated predictors. Results: Failure to decannulate occurred in 216 patients (41%). The main causes were severe intensive care unit (ICU)-acquired dysphagia (64%), long-term ventilator dependence following weaning failure (41%), excessive respiratory secretions (12%), unconsciousness (4%), and airway obstruction (3%). Predictors of unsuccessful decannulation from any cause were age [odds ratio (OR) = 1.04 year−1; 95% confidence interval (CI), 1.02–1.06; p < 0.01], body mass index [0.96 kg/m2 (0.93–1.00); p = 0.027], Acute Physiology and Chronic Health Evaluation II (APACHE-II) score [1.05 (1.00–1.10); p = 0.036], pre-existing non-invasive home ventilation [3.57 (1.51–8.45); p < 0.01], percutaneous tracheostomies [0.49 (0.30–0.80); p < 0.01], neuromuscular diseases [4.28 (1.21–15.1); p = 0.024], and total mechanical ventilation duration [1.02 day−1 (1.01–1.02); p < 0.01]. Regression models examined in subsets of patients with severe dysphagia and long-term ventilator dependence as the main reason for failure revealed little overlapping among predictors, which even showed opposite effects on the outcome. The application of non-invasive ventilation as a weaning technique contributed to successful decannulation in 96 of 221 (43%) long-term ventilator-dependent patients following weaning failure. Conclusion: Failure to decannulate after prolonged weaning occurred in 41%, mainly resulting from persistent ICU-acquired dysphagia and long-term ventilator dependence following weaning failure, each associated with its own set of predictors.

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Weaning from tracheostomy in subjects undergoing pulmonary rehabilitation

Cited by 3 publications

References 24 publications

Retrospective clinical study of tracheostomy among intubated patients of respiratory intensive care unit

Retrospective clinical study of tracheostomy among intubated patients of respiratory intensive care unit

Critérios para decanulação da traqueostomia: revisão de literatura

Incidence, causes, and predictors of unsuccessful decannulation following prolonged weaning

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