What About the Trach? Tracheotomy Removal as a Palliative Care Maneuver

Newman, Alfred; Kvale, Elizabeth; Williams, Beverly Rosa; Bailey, F. Amos

doi:10.1177/1049909107300214

Cited by 9 publications

(6 citation statements)

References 8 publications

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“…Removal of tracheostomy at end of life is rare8 but tracheostomy removal has been associated with reduced pain and dyspnoea; reduced oxygen requirement and reduced need for suctioning alongside improved ability to eat and speak 8. There are case reports of tracheostomy removal within the hospice setting with no apparent complications8 but this is rare in the community and we are unaware of any previous published reports of community removal. This patient is described by her supportive family to have been at peace with decision for removal.…”

Section: Discussionmentioning

confidence: 99%

Head and neck cancer end of life care: complex challenges

Taylor

Christie

Wakefield

2022

BMJ Support Palliat Care

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Head and neck cancers frequently carry a poor prognosis and are commonly associated with complex medical needs and symptoms. Timing of referral to specialist palliative care teams (SPCTs) is challenging. We present the case of a 57-year-old woman with locally highly advanced head and neck cancer. The patient had highly complex medical needs including a tracheostomy to maintain airway patency, artificial feeds via jejunostomy and impaired communication due to hearing loss, tracheostomy and fatigue. She required support with advance care planning and complex symptom management of pain related to abdominal skin excoriation due to leakage of gastric contents; bleeding of necrotic tumour; anxiety and discomfort due to displacement of tracheostomy. Care by an integrated SPCT allowed smooth transition from hospital to community settings with smooth ongoing management despite highly complex needs. This complex symptom management included tracheostomy removal in the home towards the end of life.

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Section: Discussionmentioning

confidence: 99%

Head and neck cancer end of life care: complex challenges

Taylor

Christie

Wakefield

2022

BMJ Support Palliat Care

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“…Instead, Ceriana and collaborators proposed a more organic approach in a group of 108 tracheotomised patients with prolonged mechanical ventilation; using a simple decision flowchart they were able to remove cannula in almost 80 % of subjects [23]. More recently, Newman and collaborators evaluated tracheostomy removal in a small group of patients recovered in a palliative care unit [24]. In addition, a recent international survey involving 309 doctors and respiratory therapists highlighted as the most popular criteria for deciding decannulation was the patient level of consciousness, cough effectiveness, secretions, and oxygenation [13].…”

Section: Discussionmentioning

confidence: 99%

Weaning from tracheostomy in subjects undergoing pulmonary rehabilitation

Pasqua¹,

Nardi²,

Provenzano³

et al. 2019

Multidis Res Med

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Background: Weaning from tracheostomy has implications in management, quality of life, and costs of ventilated patients. Furthermore, endotracheal cannula removing needs further studies. Aim of this study was the validation of a protocol for weaning from tracheostomy and evaluation of predictor factors of decannulation. Methods: Medical records of 48 patients were retrospectively evaluated. Patients were decannulated in agreement with a decannulation protocol based on the evaluation of clinical stability, expiratory muscle strength, presence of tracheal stenosis/granulomas, deglutition function, partial pressure of CO2, and PaO2/FiO2 ratio. These variables, together with underlying disease, blood gas analysis parameters, time elapsed with cannula, comordibity, Barthel index, and the condition of ventilation, were evaluated in a logistic model as predictors of decannulation. Results: 63 % of patients were successfully decannulated in agreement with our protocol and no one needed to be re-cannulated. Three variables were significantly associated with the decannulation: no pulmonary underlying diseases (OR = 7.12; 95 % CI 1.2–42.2), no mechanical ventilation (OR = 9.55; 95 % CI 2.1–44.2) and period of tracheostomy ≤10 weeks (OR = 6.5; 95 % CI 1.6–27.5). Conclusions: The positive course of decannulated patients supports the suitability of the weaning protocol we propose here. The strong predictive role of three clinical variables gives premise for new studies testing simpler decannulation protocols.

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“…Instead, Ceriana and collaborators proposed a more organic approach in a group of 108 tracheotomised patients with prolonged mechanical ventilation; using a simple decision flow-chart they were able to remove cannula in almost 80 % of subjects [ 23 ]. More recently, Newman and collaborators evaluated tracheostomy removal in a small group of patients recovered in a palliative care unit [ 24 ]. In addition, a recent international survey involving 309 doctors and respiratory therapists highlighted as the most popular criteria for deciding decannulation was the patient level of consciousness, cough effectiveness, secretions, and oxygenation [ 13 ].…”

Section: Discussionmentioning

confidence: 99%

Weaning from tracheostomy in subjects undergoing pulmonary rehabilitation

Pasqua¹,

Nardi

Provenzano

et al. 2015

Multidiscip Respir Med

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BackgroundWeaning from tracheostomy has implications in management, quality of life, and costs of ventilated patients. Furthermore, endotracheal cannula removing needs further studies. Aim of this study was the validation of a protocol for weaning from tracheostomy and evaluation of predictor factors of decannulation.MethodsMedical records of 48 patients were retrospectively evaluated. Patients were decannulated in agreement with a decannulation protocol based on the evaluation of clinical stability, expiratory muscle strength, presence of tracheal stenosis/granulomas, deglutition function, partial pressure of CO2, and PaO2/FiO2 ratio. These variables, together with underlying disease, blood gas analysis parameters, time elapsed with cannula, comordibity, Barthel index, and the condition of ventilation, were evaluated in a logistic model as predictors of decannulation.Results63 % of patients were successfully decannulated in agreement with our protocol and no one needed to be re-cannulated. Three variables were significantly associated with the decannulation: no pulmonary underlying diseases (OR = 7.12; 95 % CI 1.2–42.2), no mechanical ventilation (OR = 9.55; 95 % CI 2.1–44.2) and period of tracheostomy ≤10 weeks (OR = 6.5; 95 % CI 1.6–27.5).ConclusionsThe positive course of decannulated patients supports the suitability of the weaning protocol we propose here. The strong predictive role of three clinical variables gives premise for new studies testing simpler decannulation protocols.

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What About the Trach? Tracheotomy Removal as a Palliative Care Maneuver

Cited by 9 publications

References 8 publications

Head and neck cancer end of life care: complex challenges

Head and neck cancer end of life care: complex challenges

Weaning from tracheostomy in subjects undergoing pulmonary rehabilitation

Weaning from tracheostomy in subjects undergoing pulmonary rehabilitation

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