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Cleere EF, Read C, Prunty S, Duggan E, O'Rourke J, Moore M, Vasquez P, Young O, Subramaniam T, Skinner L, Moran T, O'Duffy F, Hennessy A, Dias A, Sheahan P, Fitzgerald CWR, Kinsella J, Lennon P, Timon CVI, Woods RSR, Shine N, Curley GF, O'Neill JP. Airway decision making in major head and neck surgery: Irish multicenter, multidisciplinary recommendations. Head Neck 2024; 46:2363-2374. [PMID: 38984517 DOI: 10.1002/hed.27868] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2024] [Revised: 06/21/2024] [Accepted: 06/30/2024] [Indexed: 07/11/2024] Open
Abstract
Major head and neck surgery poses a threat to perioperative airway patency. Adverse airway events are associated with significant morbidity, potentially leading to hypoxic brain injury and even death. Following a review of the literature, recommendations regarding airway management in head and neck surgery were developed with multicenter, multidisciplinary agreement among all Irish head and neck units. Immediate extubation is appropriate in many cases where there is a low risk of adverse airway events. Where a prolonged definitive airway is required, elective tracheostomy provides increased airway security postoperatively while delayed extubation may be appropriate in select cases to reduce postoperative morbidity. Local institutional protocols should be developed to care for a tracheostomy once inserted. We provide guidance on decision making surrounding airway management at time of head and neck surgery. All decisions should be agreed between the operating, anesthetic, and critical care teams.
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Affiliation(s)
- Eoin F Cleere
- Department of Otolaryngology - Head and Neck Surgery, Beaumont Hospital, Dublin, Ireland
| | - Christopher Read
- Department of Anaesthesia and Critical Care, Beaumont Hospital, Dublin, Ireland
| | - Sarah Prunty
- Department of Otolaryngology - Head and Neck Surgery, Beaumont Hospital, Dublin, Ireland
| | - Edel Duggan
- Department of Anaesthesia and Critical Care, Beaumont Hospital, Dublin, Ireland
| | - James O'Rourke
- Department of Anaesthesia and Critical Care, Beaumont Hospital, Dublin, Ireland
| | - Michael Moore
- Department of Anaesthesia and Critical Care, Beaumont Hospital, Dublin, Ireland
| | - Pedro Vasquez
- Department of Physiotherapy, Beaumont Hospital, Dublin, Ireland
| | - Orla Young
- Department of Otolaryngology - Head and Neck Surgery, Galway University Hospital, Galway, Ireland
| | - Thavakumar Subramaniam
- Department of Otolaryngology - Head and Neck Surgery, Galway University Hospital, Galway, Ireland
| | - Liam Skinner
- Department of Otolaryngology - Head and Neck Surgery, University Hospital Waterford, Waterford, Ireland
| | - Tom Moran
- Department of Otolaryngology - Head and Neck Surgery, Mater Misericordiae University Hospital, Dublin, Ireland
- Department of Otolaryngology - Head and Neck Surgery, St Vincent's University Hospital, Dublin, Ireland
| | - Fergal O'Duffy
- Department of Otolaryngology - Head and Neck Surgery, Mater Misericordiae University Hospital, Dublin, Ireland
- Department of Otolaryngology - Head and Neck Surgery, St Vincent's University Hospital, Dublin, Ireland
| | - Anthony Hennessy
- Department of Anaesthesiology, South Infirmary Victoria University Hospital, Cork, Ireland
| | - Andrew Dias
- Department of Otolaryngology - Head and Neck Surgery, South Infirmary Victoria University Hospital, Cork, Ireland
| | - Patrick Sheahan
- Department of Otolaryngology - Head and Neck Surgery, South Infirmary Victoria University Hospital, Cork, Ireland
- ENTO Research Unit, College of Medicine and Health, University College Cork, Cork, Ireland
| | - Conall W R Fitzgerald
- Department of Otolaryngology - Head and Neck Surgery, St James's Hospital, Dublin, Ireland
| | - John Kinsella
- Department of Otolaryngology - Head and Neck Surgery, St James's Hospital, Dublin, Ireland
| | - Paul Lennon
- Department of Otolaryngology - Head and Neck Surgery, St James's Hospital, Dublin, Ireland
| | - Conrad V I Timon
- Department of Otolaryngology - Head and Neck Surgery, St James's Hospital, Dublin, Ireland
| | - Robbie S R Woods
- Department of Otolaryngology - Head and Neck Surgery, Beaumont Hospital, Dublin, Ireland
| | - Neville Shine
- Department of Otolaryngology - Head and Neck Surgery, Beaumont Hospital, Dublin, Ireland
| | - Gerard F Curley
- Department of Anaesthesia and Critical Care, Beaumont Hospital, Dublin, Ireland
- Department of Anaesthesia and Critical Care, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - James P O'Neill
- Department of Otolaryngology - Head and Neck Surgery, Beaumont Hospital, Dublin, Ireland
- Department of Otolaryngology - Head and Neck Surgery, Royal College of Surgeons in Ireland, Dublin, Ireland
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Gallice T, Cugy E, Cugy D, Laimay J, Branchard O, Germain C, Dehail P, Cuny E, Engelhardt J. Effect of a Speaking Valve on Nasal Airflow During Tracheostomy Weaning: A Case Series. Neurocrit Care 2024:10.1007/s12028-024-01966-8. [PMID: 38506973 DOI: 10.1007/s12028-024-01966-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2023] [Accepted: 02/21/2024] [Indexed: 03/22/2024]
Affiliation(s)
- Thomas Gallice
- Aging, Chronic Diseases, Technology, Disability, and Environment Team, Bordeaux Research Center for Population Health, Bordeaux Segalen University, UMR_S 1219, 33000, Bordeaux, France.
- Swallowing Evaluation Unit, Physical and Rehabilitation Medicine Unit, Tastet-Girard Hospital, Bordeaux University Hospital, 33000, Bordeaux, France.
- Neurosurgery Unit B, Pellegrin Hospital, Bordeaux University Hospital, 33000, Bordeaux, France.
- Neurological Intensive Care Unit, Pellegrin Hospital, Bordeaux University Hospital, 33000, Bordeaux, France.
| | - Emmanuelle Cugy
- Swallowing Evaluation Unit, Physical and Rehabilitation Medicine Unit, Tastet-Girard Hospital, Bordeaux University Hospital, 33000, Bordeaux, France
- Physical and Rehabilitation Medicine Unit, Arcachon Hospital, 33260, La Teste de Buch, France
- Physical and Rehabilitation Medicine Unit, Tastet-Girard Hospital, Bordeaux University Hospital, 33000, Bordeaux, France
| | - Didier Cugy
- Sleep Medicine Unit, Pellegrin Hospital, Bordeaux University Hospital, 33000, Bordeaux, France
| | - Julie Laimay
- Neurosurgery Unit B, Pellegrin Hospital, Bordeaux University Hospital, 33000, Bordeaux, France
- Neurological Intensive Care Unit, Pellegrin Hospital, Bordeaux University Hospital, 33000, Bordeaux, France
| | - Olivier Branchard
- Neurosurgery Unit B, Pellegrin Hospital, Bordeaux University Hospital, 33000, Bordeaux, France
| | - Christine Germain
- Medical Information Unit, Pellegrin Hospital, Bordeaux University Hospital, 33000, Bordeaux, France
| | - Patrick Dehail
- Aging, Chronic Diseases, Technology, Disability, and Environment Team, Bordeaux Research Center for Population Health, Bordeaux Segalen University, UMR_S 1219, 33000, Bordeaux, France
- Physical and Rehabilitation Medicine Unit, Tastet-Girard Hospital, Bordeaux University Hospital, 33000, Bordeaux, France
| | - Emmanuel Cuny
- Neurosurgery Unit B, Pellegrin Hospital, Bordeaux University Hospital, 33000, Bordeaux, France
- Neurodegenerative Diseases Institute, Bordeaux University, 33000, Bordeaux, France
- CNRS, Neurodegenerative Diseases Institute, 33000, Bordeaux, France
| | - Julien Engelhardt
- Neurosurgery Unit B, Pellegrin Hospital, Bordeaux University Hospital, 33000, Bordeaux, France
- Polytechnic Institute of Bordeaux, Centre National de la Recherche Scientifique, Institut de Mathématiques de Bordeaux, Bordeaux University, 33400, Bordeaux, France
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Ninan A, Grubb LM, Brenner MJ, Pandian V. Effectiveness of interprofessional tracheostomy teams: A systematic review. J Clin Nurs 2023; 32:6967-6986. [PMID: 37395139 DOI: 10.1111/jocn.16815] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2023] [Revised: 05/19/2023] [Accepted: 06/19/2023] [Indexed: 07/04/2023]
Abstract
AIM(S) To systematically locate, evaluate and synthesize evidence regarding effectiveness of interprofessional tracheostomy teams in increasing speaking valve use and decreasing time to speech and decannulation, adverse events, lengths of stay (intensive care unit (ICU) and hospital) and mortality. In addition, to evaluate facilitators and barriers to implementing an interprofessional tracheostomy team in hospital settings. DESIGN Systematic review using Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) and Johns Hopkins Nursing Evidence-Based Practice Model's guidance. METHODS Our clinical question: Do interprofessional tracheostomy teams increase speaking valve use and decrease time to speech and decannulation, adverse events, lengths of stay and mortality? Primary studies involving adult patients with a tracheostomy were included. Eligible studies were systematically reviewed by two reviewers and verified by another two reviewers. DATA SOURCES MEDLINE, CINAHL and EMBASE. RESULTS Fourteen studies met eligibility criteria; primarily pre-post intervention cohort studies. Percent increase in speaking valve use ranged 14%-275%; percent reduction in median days to speech ranged 33%-73% and median days to decannulation ranged 26%-32%; percent reduction in rate of adverse events ranged 32%-88%; percent reduction in median hospital length of stay days ranged 18-40 days; no significant change in overall ICU length of stay and mortality rates. Facilitators include team education, coverage, rounds, standardization, communication, lead personnel and automation, patient tracking; barrier is financial. CONCLUSION Patients with tracheostomy who received care from a dedicated interprofessional team showed improvements in several clinical outcomes. IMPLICATIONS FOR PATIENT CARE Additional high-quality evidence from rigorous, well-controlled and adequately powered studies are necessary, as are implementation strategies to promote broader adoption of interprofessional tracheostomy team strategies. Interprofessional tracheostomy teams are associated with improved safety and quality of care. IMPACT Evidence from review provides rationale for broader implementation of interprofessional tracheostomy teams. REPORTING METHOD PRISMA and Synthesis Without Meta-analysis (SWiM). PATIENT/PUBLIC CONTRIBUTION None.
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Affiliation(s)
- Ashly Ninan
- Johns Hopkins University, Baltimore, Maryland, USA
| | - Lisa M Grubb
- Department of Nursing Faculty, Johns Hopkins University School of Nursing, Baltimore, Maryland, USA
| | - Michael J Brenner
- Department of Otolaryngology-Head & Neck Surgery, University of Michigan, Ann Arbor, Michigan, USA
- Global Tracheostomy Collaborative, Raleigh, North Carolina, USA
| | - Vinciya Pandian
- Department of Nursing Faculty, and Outcomes After Critical Illness and Surgery (OACIS) Research Group, Johns Hopkins University, Baltimore, Maryland, USA
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Spiegel DR, Kim C, Hargis AL, Penn AJ, Soohoo KG, Francis M. A Case of Acute Conditioned Dyspnea During Tracheostomy Weaning Treated Successfully With Adjunctive Mirtazapine. J Clin Psychopharmacol 2023; 43:67-69. [PMID: 36584253 DOI: 10.1097/jcp.0000000000001637] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
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Tracheostomy decannulation protocol in patients with prolonged tracheostomy referred to a rehabilitation hospital: a prospective cohort study. J Intensive Care 2022; 10:34. [PMID: 35842715 PMCID: PMC9288052 DOI: 10.1186/s40560-022-00626-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2022] [Accepted: 07/05/2022] [Indexed: 11/15/2022] Open
Abstract
Background The aim of the study was to assess the feasibility of a standardized tracheostomy decannulation protocol in patients with prolonged tracheostomy referred to a rehabilitation hospital. Methods This prospective cohort study recruited conscious patients with prolonged tracheostomy who were referred to the pulmonary rehabilitation department of a tertiary rehabilitation hospital between January 2019 and December 2021. A pulmonary rehabilitation team used a standardized tracheostomy decannulation protocol developed by the authors. The primary outcome was the success rate of decannulation. Secondary outcomes included decannulation time from referral and reintubation rate after a follow-up of 3 months. Results Of the 115 patients referred for weaning from mechanical ventilation and tracheostomy decannulation over the study period, 80.0% (92/115) were finally evaluated for tracheostomy decannulation. The mean time of tracheostomy in patients transferred to our department was 70.6 days. After assessment by a multidisciplinary team, 57 patients met all the decannulation indications and underwent decannulation. Fifty-six cases were successful, and 1 case was intubated again. The median time to decannulation after referral was 42.7 days. Reintubation after a follow-up of 3 months did not occur in any patients. Conclusions A standardized tracheostomy decannulation protocol implemented by a pulmonary rehabilitation team is associated with successful tracheostomy decannulation in patients with prolonged tracheostomy. Not every tracheostomy patient must undergo upper airway endoscopy before decannulation. Tolerance of speaking valve continuously for 4 h can be used as an alternative means for tube occlusion. A swallow assessment was used to evaluate the feeding mode and did not affect the final decision to decannulate. Trial registration: 2018bkky-121.
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6
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Sun GH, Chen SW, MacEachern MP, Wang J. Successful decannulation of patients with traumatic spinal cord injury: A scoping review. J Spinal Cord Med 2022; 45:498-509. [PMID: 33166214 PMCID: PMC9246262 DOI: 10.1080/10790268.2020.1832397] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
Abstract
Context: Patients with spinal cord injury (SCI) often require tracheostomy as an immediate life-saving measure. Successful decannulation, or removal of the tracheostomy, improves patient quality of life, function, and physical appearance and is considered an important rehabilitative milestone for SCI patients.Objective: We sought to synthesize the existing published literature on SCI patients undergoing decannulation.Methods: Ovid MEDLINE, Embase, Web of Science, CINAHL, and Cochrane Central Register of Controlled Trials were systematically searched through July 2, 2019 using appropriate keywords and MeSH terms pertaining to tracheostomy and SCI. Searches were human-subject only without language restrictions. Published literature discussing the outcomes of SCI patients who underwent decannulation were screened using inclusion/exclusion criteria determined a priori and reviewed.Results: Twenty-six publications were eligible for review and synthesis out of 1,493 unique articles. Over half of the studies were retrospective case series or reports. The research was nearly all published within the fields of physical medicine and rehabilitation, neurology, and pulmonary/critical care. Three themes emerged from review: (1) interdisciplinary or multidisciplinary tracheostomy team management to optimize decannulation processes, (2) non-invasive intermittent positive-pressure ventilatory support instead of tracheostomy-based ventilator support, and (3) wide variation in the reporting of post-decannulation clinical outcomes.Conclusion: Published research lacks a consistent taxonomy for reporting post-decannulation outcomes in SCI patients. Non-invasive ventilation research could benefit many SCI patients but has been studied in depth primarily by a single authorship group. Further investigation into the socioeconomic and fiscal impact on tracheostomies on SCI patients is warranted.
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Affiliation(s)
- Gordon H. Sun
- Department of Perioperative Services, Rancho Los Amigos National Rehabilitation Center, Downey, California, USA,Correspondence to: Gordon H. Sun, 7601 E. Imperial Highway, Downey, CA90242, USA.
| | - Stephanie W. Chen
- Department of Pediatrics, Rancho Los Amigos National Rehabilitation Center, Downey, California, USA
| | - Mark P. MacEachern
- Taubman Health Sciences Library, University of Michigan, Ann Arbor, Michigan, USA
| | - Jing Wang
- Aiken Regional Medical Center, Aiken, South Carolina, USA
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Sikha DSB, Prakash DNB, Thomas DNC, John DJA, Mathews DSS, Mannam DP, George DP. ROLE OF ULTRASONOGRAPHY IN UPPER AIRWAY ASSESSMENT FOR DECANNULATING TRACHEOSTOMY IN ACQUIRED BRAIN INJURY - A PILOT STUDY. Arch Phys Med Rehabil 2022; 103:2174-2179. [PMID: 35202583 DOI: 10.1016/j.apmr.2022.01.158] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2021] [Revised: 01/06/2022] [Accepted: 01/26/2022] [Indexed: 11/02/2022]
Abstract
OBJECTIVE To compare the findings of ultrasonography of the upper airway with flexible fiberoptic laryngoscopy and determine the efficacy of transcutaneous laryngeal ultrasonography for decannulation. DESIGN Prospective cross sectional study SETTING: Tertiary care referral centre in South India PARTICIPANTS: Twenty- four patients with acquired brain injury MAIN OUTCOME MEASURES: Participants underwent an airway assessment by ultrasonography followed by assessment of airway by flexible laryngoscopy done within the next 72 hours. RESULTS Vocal cord assessment by ultrasonography revealed a sensitivity of 81.2% and specificity of 87.5%. A statistically significant association between vocal cord mobility as assessed by ultrasonography and decannulation was observed (sensitivity of 81.25%, specificity of 87.5%, p= 0.002). Although aspiration was not assessed by ultrasonography, a statistically significant association was observed between vocal cord mobility on ultrasonography and aspiration as assessed by laryngoscopy (sensitivity of 81.25%, specificity of 87.5%, p= 0.011). CONCLUSION Laryngeal ultrasonography is an emerging diagnostic modality with a potential role for assessing vocal cord mobility and airway prior to decannulation in centres which lack the expertise and the infrastructure to perform a flexible laryngoscopy.
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Affiliation(s)
- Dr Samuel Barnabas Sikha
- Department of Physical Medicine and Rehabilitation, Christian Medical College, Vellore, Tamil Nadu, India
| | - Dr Navin B Prakash
- Department of Physical Medicine and Rehabilitation, Christian Medical College, Vellore, Tamil Nadu, India
| | - Dr Naveen Cherian Thomas
- Department of Physical Medicine and Rehabilitation, Christian Medical College, Vellore, Tamil Nadu, India
| | - Dr Judy Ann John
- Department of Physical Medicine and Rehabilitation, Christian Medical College, Vellore, Tamil Nadu, India.
| | | | - Dr Pavithra Mannam
- Department of Radiology, Christian Medical College, Vellore, Tamil Nadu, India
| | - Dr Philip George
- Department of E.N.T, Christian Medical College, Vellore, Tamil Nadu, India
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Sood RN, Palleiko BA, Alape-Moya D, Maxfield MW, Holdorf J, Uy KF. COVID-19 Tracheostomy: Experience in a University Hospital With Intermediate Follow-up. J Intensive Care Med 2021; 36:1507-1512. [PMID: 34713733 PMCID: PMC8600586 DOI: 10.1177/08850666211043436] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
The benefits of percutaneous dilational tracheostomy (PDT) placement have been
well documented in patients requiring prolonged mechanical ventilation. However,
the data regarding the benefit of PDT in coronavirus-2019 (COVID-19) patients
are scarce. The objective of this study is to evaluate the outcomes of a cohort
of 37 patients who underwent tracheostomy as part of their COVID-19 care.
Retrospective data from a series for 37 patients undergoing tracheostomy was
collected using chart review. Primary outcomes included 30 and 60 day mortality,
weaning rate, and decannulation rate. Secondary outcomes collected included
admission demographics, comorbidities, and procedural information. Thirty-seven
(37) patients requiring prolonged mechanical ventilation due to COVID-19. Of
these 37 patients, 35 were alive 60 days post-PDT placement, 33 have been weaned
from mechanical ventilation and 18 have been decannulated. The low mortality and
high decannulation rates in this cohort in is a promising development in the
care of critically ill COVID-19 patients. Of note, all participating physicians
underwent routine polymerase chain reaction (PCR) testing for infection with the
severe acute respiratory syndrome coronavirus-2 virus and no physician
contracted COVID-19 as a result of their involvement. Overall, this case series
describes the modified PDT technique used by our team and discusses the
feasibility and potential benefit to PDT placement in COVID-19 patients
requiring long-term mechanical ventilation.
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Affiliation(s)
- Rahul N Sood
- UMass Memorial Medical Center, Worcester, MA, USA
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Mannini A, Hakiki B, Liuzzi P, Campagnini S, Romoli A, Draghi F, Macchi C, Carrozza MC. Data-driven prediction of decannulation probability and timing in patients with severe acquired brain injury. COMPUTER METHODS AND PROGRAMS IN BIOMEDICINE 2021; 209:106345. [PMID: 34419756 DOI: 10.1016/j.cmpb.2021.106345] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/20/2021] [Accepted: 08/02/2021] [Indexed: 06/13/2023]
Abstract
BACKGROUND AND OBJECTIVES From a rehabilitation perspective, removal of tracheostomy in patients with severe acquired brain injuries (sABI) is a crucial step. Predictive parameters for a successful decannulation are currently still a focus of the research for sABI patients, especially for those presenting a disorder of consciousness. For this reason, we adopted a data-driven approach predicting decannulation probability and timing using ensemble learning models in patients in intensive rehabilitation units. METHODS 327 patients, 186 of which were successfully decannulated during their intensive rehabilitative stay, were recruited in a non-concurrent retrospective study. Decannulation probability and timing were predicted using data available within one week from admission at the rehabilitation unit. Two predictive models were trained and cross-validated independently, with the first being an ensemble of a Support Vector Machine and Random Forests and the second an Adaptive Boosting with a Support Vector Regression as weak learner. Confusion matrix, accuracy and AUC were considered as evaluation metrics for the classifier and median absolute error was considered for the regressor. To quantify the advantages in the clinical practice of using the latter prediction, we compared timing estimation with a timing guess (median) calculated on available data. The comparison was based on a Wilcoxon signed rank test. RESULTS Decannulation probability was successfully predicted with an accuracy of 84.8% (AUC = 0.85) and timing with a median absolute error of 25.7 days [IQR = 25.6]. This resulted in a significant improvement with respect to the weaning time guess (p<0.05) with an effect size of 71.7%. Furthermore, dichotomizing the regression prediction with a threshold (3 months from the event), resulted in a prediction accuracy of 77.5% (AUC = 0.82) on the test set. DISCUSSIONS A model capable of providing a prediction on decannulation probability and timing was developed and cross-validated, built on data taken at admission to the intensive rehabilitation unit. Translated in clinical practice, this information can support the clinical decision process and provide a mean to improve both in-hospital and domiciliary care organization.
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Affiliation(s)
- Andrea Mannini
- IRCCS Fondazione Don Carlo Gnocchi, via di Scandicci 269, Firenze 50134, FI, Italy; the BioRobotics Institute, Scuola Superiore Sant'Anna, Pontedera 56025, PI, Italy
| | - Bahia Hakiki
- IRCCS Fondazione Don Carlo Gnocchi, via di Scandicci 269, Firenze 50134, FI, Italy
| | - Piergiuseppe Liuzzi
- IRCCS Fondazione Don Carlo Gnocchi, via di Scandicci 269, Firenze 50134, FI, Italy; the BioRobotics Institute, Scuola Superiore Sant'Anna, Pontedera 56025, PI, Italy.
| | - Silvia Campagnini
- IRCCS Fondazione Don Carlo Gnocchi, via di Scandicci 269, Firenze 50134, FI, Italy; the BioRobotics Institute, Scuola Superiore Sant'Anna, Pontedera 56025, PI, Italy
| | - Annamaria Romoli
- IRCCS Fondazione Don Carlo Gnocchi, via di Scandicci 269, Firenze 50134, FI, Italy
| | - Francesca Draghi
- IRCCS Fondazione Don Carlo Gnocchi, via di Scandicci 269, Firenze 50134, FI, Italy
| | - Claudio Macchi
- IRCCS Fondazione Don Carlo Gnocchi, via di Scandicci 269, Firenze 50134, FI, Italy; Dep. of Experimental and Clinical Medicine, University of Florence, Piazza S. Marco 4, Firenze 50121, FI, Italy
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10
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Clinical Approach to Decision-Making in Nasogastric Tube Weaning and Tracheostomy Tube Decannulation. J Maxillofac Oral Surg 2021; 20:510-511. [PMID: 34408382 DOI: 10.1007/s12663-021-01534-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2021] [Accepted: 02/19/2021] [Indexed: 10/21/2022] Open
Abstract
Extensive resections for advanced malignancies of the oral cavity quite often require patients to have a tracheostomy tube and nasogastric tube for prolonged periods leading to dependence. Timely and safe removal of these tubes would help hasten the recovery and rehabilitation of these patients. A simple bedside protocol for evaluation and weaning of nasogastric tube and tracheostomy tube is outlined in this communication. This would help health care workers in resource-poor settings make safe clinical decisions and improve care.
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11
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Muhle P, Suntrup-Krueger S, Burkardt K, Lapa S, Ogawa M, Claus I, Labeit B, Ahring S, Oelenberg S, Warnecke T, Dziewas R. Standardized Endoscopic Swallowing Evaluation for Tracheostomy Decannulation in Critically Ill Neurologic Patients - a prospective evaluation. Neurol Res Pract 2021; 3:26. [PMID: 33966636 PMCID: PMC8108459 DOI: 10.1186/s42466-021-00124-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2021] [Accepted: 04/22/2021] [Indexed: 12/16/2022] Open
Abstract
Background Removal of a tracheostomy tube in critically ill neurologic patients is a critical issue during intensive care treatment, particularly due to severe dysphagia and insufficient airway protection. The “Standardized Endoscopic Evaluation for Tracheostomy Decannulation in Critically Ill Neurologic Patients” (SESETD) is an objective measure of readiness for decannulation. This protocol includes the stepwise evaluation of secretion management, spontaneous swallowing, and laryngeal sensitivity during fiberoptic endoscopic evaluation of swallowing (FEES). Here, we first evaluated safety and secondly effectiveness of the protocol and sought to identify predictors of decannulation success and decannulation failure. Methods A prospective observational study was conducted in the neurological intensive care unit at Münster University Hospital, Germany between January 2013 and December 2017. Three hundred and seventy-seven tracheostomized patients with an acute neurologic disease completely weaned from mechanical ventilation were included, all of whom were examined by FEES within 72 h from end of mechanical ventilation. Using regression analysis, predictors of successful decannulation, as well as decannulation failure were investigated. Results Two hundred and twenty-seven patients (60.2%) could be decannulated during their stay according to the protocol, 59 of whom within 24 h from the initial FEES after completed weaning. 3.5% of patients had to be recannulated due to severe dysphagia or related complications. Prolonged mechanical ventilation showed to be a significant predictor of decannulation failure. Lower age was identified to be a significant predictor of early decannulation after end of weaning. Transforming the binary SESETD into a 4-point scale helped predicting decannulation success in patients not immediately ready for decannulation after the end of respiratory weaning (optimal cutoff ≥1; sensitivity: 64%, specifity: 66%). Conclusions The SESETD showed to be a safe and efficient tool to evaluate readiness for decannulation in our patient collective of critically ill neurologic patients. Supplementary Information The online version contains supplementary material available at 10.1186/s42466-021-00124-1.
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Affiliation(s)
- Paul Muhle
- University Hospital Muenster, Department of Neurology with Institute for Translational Neurology, Albert-Schweitzer-Campus 1 A, 48149, Muenster, Germany. .,Institute for Biomagnetism and Biosignalanalysis, University Hospital Muenster, Malmedyweg 15, 48149, Muenster, Germany.
| | - Sonja Suntrup-Krueger
- University Hospital Muenster, Department of Neurology with Institute for Translational Neurology, Albert-Schweitzer-Campus 1 A, 48149, Muenster, Germany.,Institute for Biomagnetism and Biosignalanalysis, University Hospital Muenster, Malmedyweg 15, 48149, Muenster, Germany
| | - Karoline Burkardt
- Raphaelsklinik Muenster, Department of General Surgery, Loerstraße 23, 48143, Muenster, Germany
| | - Sriramya Lapa
- University Hospital Frankfurt, Department of Neurology, Theodor-Stern-Kai 7, 60590, Frankfurt/Main, Germany
| | - Mao Ogawa
- Department of Rehabilitation Medicine I, School of Medicine, Fujita Health University, Toyoake, Aichi, Japan
| | - Inga Claus
- University Hospital Muenster, Department of Neurology with Institute for Translational Neurology, Albert-Schweitzer-Campus 1 A, 48149, Muenster, Germany
| | - Bendix Labeit
- University Hospital Muenster, Department of Neurology with Institute for Translational Neurology, Albert-Schweitzer-Campus 1 A, 48149, Muenster, Germany.,Institute for Biomagnetism and Biosignalanalysis, University Hospital Muenster, Malmedyweg 15, 48149, Muenster, Germany
| | - Sigrid Ahring
- University Hospital Muenster, Department of Neurology with Institute for Translational Neurology, Albert-Schweitzer-Campus 1 A, 48149, Muenster, Germany
| | - Stephan Oelenberg
- University Hospital Muenster, Department of Neurology with Institute for Translational Neurology, Albert-Schweitzer-Campus 1 A, 48149, Muenster, Germany
| | - Tobias Warnecke
- University Hospital Muenster, Department of Neurology with Institute for Translational Neurology, Albert-Schweitzer-Campus 1 A, 48149, Muenster, Germany
| | - Rainer Dziewas
- Klinikum Osnabrück, Department of Neurology, Am Finkenhügel 1, 49076, Osnabrück, Germany
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Reply: Speaking Valve Placement: Use of Manometry and Downsizing. Ann Am Thorac Soc 2021; 18:1928-1929. [PMID: 33956570 PMCID: PMC8641842 DOI: 10.1513/annalsats.202104-500le] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Meister KD, Pandian V, Hillel AT, Walsh BK, Brodsky MB, Balakrishnan K, Best SR, Chinn SB, Cramer JD, Graboyes EM, McGrath BA, Rassekh CH, Bedwell JR, Brenner MJ. Multidisciplinary Safety Recommendations After Tracheostomy During COVID-19 Pandemic: State of the Art Review. Otolaryngol Head Neck Surg 2021; 164:984-1000. [PMID: 32960148 PMCID: PMC8198753 DOI: 10.1177/0194599820961990] [Citation(s) in RCA: 28] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2020] [Accepted: 09/06/2020] [Indexed: 12/11/2022]
Abstract
OBJECTIVE In the chronic phase of the COVID-19 pandemic, questions have arisen regarding the care of patients with a tracheostomy and downstream management. This review addresses gaps in the literature regarding posttracheostomy care, emphasizing safety of multidisciplinary teams, coordinating complex care needs, and identifying and managing late complications of prolonged intubation and tracheostomy. DATA SOURCES PubMed, Cochrane Library, Scopus, Google Scholar, institutional guidance documents. REVIEW METHODS Literature through June 2020 on the care of patients with a tracheostomy was reviewed, including consensus statements, clinical practice guidelines, institutional guidance, and scientific literature on COVID-19 and SARS-CoV-2 virology and immunology. Where data were lacking, expert opinions were aggregated and adjudicated to arrive at consensus recommendations. CONCLUSIONS Best practices in caring for patients after a tracheostomy during the COVID-19 pandemic are multifaceted, encompassing precautions during aerosol-generating procedures; minimizing exposure risks to health care workers, caregivers, and patients; ensuring safe, timely tracheostomy care; and identifying and managing laryngotracheal injury, such as vocal fold injury, posterior glottic stenosis, and subglottic stenosis that may affect speech, swallowing, and airway protection. We present recommended approaches to tracheostomy care, outlining modifications to conventional algorithms, raising vigilance for heightened risks of bleeding or other complications, and offering recommendations for personal protective equipment, equipment, care protocols, and personnel. IMPLICATIONS FOR PRACTICE Treatment of patients with a tracheostomy in the COVID-19 pandemic requires foresight and may rival procedural considerations in tracheostomy in their complexity. By considering patient-specific factors, mitigating transmission risks, optimizing the clinical environment, and detecting late manifestations of severe COVID-19, clinicians can ensure due vigilance and quality care.
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Affiliation(s)
- Kara D. Meister
- Clinical Assistant Professor, Aerodigestive and Airway Reconstruction Center, Lucile Packard Children’s Hospital, Stanford Children’s Health, Stanford, Palo Alto, California, United States
- Clinical Assistant Professor, Center for Pediatric Voice and Swallowing Disorders, Department of Otolaryngology – Head & Neck Surgery, Division of Pediatric Otolaryngology, Lucile Packard Children’s Hospital, Stanford Children’s Health, Stanford, Palo Alto, California, United States
| | - Vinciya Pandian
- Associate Professor, Department of Nursing Faculty, Johns Hopkins University, Baltimore, Maryland, United States
- Outcomes After Critical Illness and Surgery (OACIS) Research Group, Johns Hopkins University, Baltimore, Maryland, United States
| | - Alexander T. Hillel
- Associate Professor, Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins University, Baltimore, Maryland, United States
| | - Brian K. Walsh
- Professor, Department of Health Sciences, Liberty University, Lynchburg, United States
| | - Martin B. Brodsky
- Outcomes After Critical Illness and Surgery (OACIS) Research Group, Johns Hopkins University, Baltimore, Maryland, United States
- Associate Professor, Department of Physical and Rehabilitation, Johns Hopkins University, Baltimore, Maryland, United States
- Division of Pulmonary and Critical Care Medicine, Johns Hopkins University, Baltimore, MD, United States
| | - Karthik Balakrishnan
- Clinical Assistant Professor, Aerodigestive and Airway Reconstruction Center, Lucile Packard Children’s Hospital, Stanford Children’s Health, Stanford, Palo Alto, California, United States
- Clinical Assistant Professor, Center for Pediatric Voice and Swallowing Disorders, Department of Otolaryngology – Head & Neck Surgery, Division of Pediatric Otolaryngology, Lucile Packard Children’s Hospital, Stanford Children’s Health, Stanford, Palo Alto, California, United States
| | - Simon R. Best
- Associate Professor, Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins University, Baltimore, Maryland, United States
| | - Steven B. Chinn
- Assistant Professor, Department of Otolaryngology – Head and Neck Surgery, University of Michigan, Michigan, United States
| | - John D. Cramer
- Assistant Professor, Department of Otolaryngology – Head and Neck Surgery, Wayne State University School of Medicine, Detroit, Michigan, United States
| | - Evan M. Graboyes
- Assistant Professor, Department of Otolaryngology-Head and Neck Surgery, Medical University of South Carolina, Charleston, South Carolina, United States
- Hollings Cancer Center, Charleston, South Carolina, United States
| | - Brendan A. McGrath
- Anesthesiology Consultant, University of Manchester, NHS Foundation Trust, National Tracheostomy Safety Project, Manchester, United Kingdom
| | - Christopher H. Rassekh
- Professor, Department of Otolaryngology-Head and Neck Surgery, University of Pennsylvania, Philadelphia, Pennsylvania, United States
| | - Joshua R. Bedwell
- Associate Professor, Baylor College of Medicine, Houston, Texas, United States
- Associate Professor, Division of Pediatric Otolaryngology-Head and Neck Surgery, Texas Children’s Hospital, Houston, Texas, United States
| | - Michael J. Brenner
- Associate Professor, Department of Otolaryngology – Head & Neck Surgery, University of Michigan, Ann Arbor, Michigan, United States, and President-elect, Global Tracheostomy Collaborative, Raleigh, North Carolina, United States
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Park C, Ko RE, Jung J, Na SJ, Jeon K. Prediction of successful de-cannulation of tracheostomised patients in medical intensive care units. Respir Res 2021; 22:131. [PMID: 33910566 PMCID: PMC8080087 DOI: 10.1186/s12931-021-01732-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2020] [Accepted: 04/25/2021] [Indexed: 11/28/2022] Open
Abstract
Background Limited data are available on practical predictors of successful de-cannulation among the patients who undergo tracheostomies. We evaluated factors associated with failed de-cannulations to develop a prediction model that could be easily be used at the time of weaning from MV. Methods In a retrospective cohort of 346 tracheostomised patients managed by a standardized de-cannulation program, multivariable logistic regression analysis identified variables that were independently associated with failed de-cannulation. Based on the logistic regression analysis, the new predictive scoring system for successful de-cannulation, referred to as the DECAN score, was developed and then internally validated. Results The model included age > 67 years, body mass index < 22 kg/m2, underlying malignancy, non-respiratory causes of mechanical ventilation (MV), presence of neurologic disease, vasopressor requirement, and presence of post-tracheostomy pneumonia, presence of delirium. The DECAN score was associated with good calibration (goodness-of-fit, 0.6477) and discrimination outcomes (area under the receiver operating characteristic curve 0.890, 95% CI 0.853–0.921). The optimal cut-off point for the DECAN score for the prediction of the successful de-cannulation was ≤ 5 points, and was associated with the specificities of 84.6% (95% CI 77.7–90.0) and sensitivities of 80.2% (95% CI 73.9–85.5). Conclusions The DECAN score for tracheostomised patients who are successfully weaned from prolonged MV can be computed at the time of weaning to assess the probability of de-cannulation based on readily available variables.
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Affiliation(s)
- Chul Park
- Department of Critical Care Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul, 06351, Republic of Korea.,Department of Pulmonary Medicine, Wonkwang Medical Center, Iksan, Republic of Korea
| | - Ryoung-Eun Ko
- Department of Critical Care Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul, 06351, Republic of Korea
| | - Jinhee Jung
- Intensive Care Unit Nursing Department, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Soo Jin Na
- Department of Critical Care Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul, 06351, Republic of Korea
| | - Kyeongman Jeon
- Department of Critical Care Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul, 06351, Republic of Korea. .,Division of Pulmonary and Critical Care Medicine, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul, 06351, Republic of Korea.
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Karlic KJ, Espinosa NM, Fleming BE, Helman JL, Krawcke KA, Thatcher AL. The low value of pre-decannulation capped overnight ICU monitoring for pediatric patients. Int J Pediatr Otorhinolaryngol 2021; 143:110634. [PMID: 33588356 DOI: 10.1016/j.ijporl.2021.110634] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2020] [Revised: 12/10/2020] [Accepted: 01/22/2021] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To determine the value of pre-decannulation capped overnight ICU monitoring for assessing decannulation-readiness in pediatric patients. METHODS This study included all pediatric patients, age 18 and under, with a tracheostomy attempting decannulation at the University of Michigan between 2013 and 2018. Patients who underwent major airway reconstruction immediately prior to decannulation were excluded. Descriptive and comparative statistics were calculated to compare the sub-group of patients who underwent pre-decannulation capped overnight ICU monitoring to those who did not. RESULTS 125 pediatric patients attempted decannulation for a total of 126 attempts with 105 attempts being eligible for inclusion. 75 eligible attempts included pre-decannulation capped overnight ICU monitoring, while 30 did not. Subsequent rates of successful decannulation were 97.33% (73/75) and 100.00% (30/30), respectively (P = 0.366; 95% CI -8.818-9.260). The pre-decannulation capped overnight ICU monitoring passing rate was 98.67% (74/75) despite a complication rate of 5.33% (4/75). Post-decannulation, 98.08% (102/104) of decannulated patients were monitored inpatient for a minimum of 24 h DISCUSSION: With similar rates of successful decannulation among both sub-groups and previous research demonstrating sufficient ambulatory testing accurately predicts successful decannulation, pre-decannulation capped overnight ICU monitoring is a low-value, high-cost test that can be safely discontinued without compromising patient care. Notably, our study excluded patients undergoing open airway reconstruction immediately prior to decannulation. The 24-h monitoring post-decannulation serves as a safety net for individuals who ultimately fail decannulation.
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Affiliation(s)
- Kevin J Karlic
- University of Michigan Medical School, 1301 Catherine St, Ann Arbor, MI, 48109, USA; Michigan Medicine, 1500 E Medical Center Dr, Ann Arbor, MI, 48109, USA.
| | - Nico M Espinosa
- University of Michigan Medical School, 1301 Catherine St, Ann Arbor, MI, 48109, USA; Michigan Medicine, 1500 E Medical Center Dr, Ann Arbor, MI, 48109, USA.
| | | | - Jennifer L Helman
- Michigan Medicine, 1500 E Medical Center Dr, Ann Arbor, MI, 48109, USA.
| | - Kelly A Krawcke
- Michigan Medicine, 1500 E Medical Center Dr, Ann Arbor, MI, 48109, USA.
| | - Aaron L Thatcher
- University of Michigan Medical School, 1301 Catherine St, Ann Arbor, MI, 48109, USA; Michigan Medicine, 1500 E Medical Center Dr, Ann Arbor, MI, 48109, USA.
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Standard versus Accelerated Speaking Valve Placement after Percutaneous Tracheostomy: A Randomized-Controlled Feasibility Study. Ann Am Thorac Soc 2021; 18:1693-1701. [PMID: 33760713 DOI: 10.1513/annalsats.202010-1282oc] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
RATIONALE Feasibility of a large, multi-center, randomized controlled trial (RCT) comparing the risks and benefits of early use speaking valve following tracheostomy is not clear. OBJECTIVE To investigate the feasibility of accelerated (≤ 24 hours) versus standard (≥ 48 hours) one-way speaking valve ("speaking valve") placement after percutaneous tracheostomy. METHOD Twenty awake patients (Glasgow Coma Scale score >9) were randomized to accelerated or standard timing of speaking valve placement. Outcomes included patient identification and recruitment, adherence to protocol-defined time windows for valve placement, experimental separation in time to first speaking valve placement between groups, effectiveness of speech and swallowing (sentence intelligibility test [SIT] score, patient-reported quality of life [QOL]), and clinical outcomes (safety events, speaking valve tolerance, decannulation, length of stay, mortality). RESULTS Of 161 patients undergoing percutaneous tracheostomy, 20 of 36 meeting eligibility criteria were randomized. The median time to speaking valve placement was 22 (IQR: 21, 23) hours in the accelerated arm versus 45.5 (IQR: 43, 50) hours for the standard arm. No aspiration, hypoxemia, or other safety events occurred in either arm as a result of the speaking valve. SIT scores were not different between arms but correlated with QOL. After 3 sessions, patients in the accelerated arm tolerated longer speaking valve trials than the standard arm [Median (IQR): 65 (45 - 720) vs. 15 (3-20) minutes]. Seven patients in the accelerated arm were decannulated before hospital discharge versus one patient in the standard arm. CONCLUSIONS Speaking valve placement within 24 hours of percutaneous tracheostomy is feasible. A multicenter, randomized, control trial should be conducted to evaluate the safety of this strategy and compare important clinical outcomes, including time to speech and swallow recovery following tracheostomy. Clinical trial registered with ClinicalTrials.gov (NCT03008174).
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Affiliation(s)
| | - Brendan A McGrath
- Manchester University NHS Foundation Trust, Manchester, United Kingdom
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Youssef G, Abdulla KM. Value of endoscopic examination of airways and swallowing in tracheostomy decannulation. THE EGYPTIAN JOURNAL OF OTOLARYNGOLOGY 2020. [PMCID: PMC7269700 DOI: 10.1186/s43163-020-00001-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
Abstract
Background
Tracheostomy decannulation decision is the major challenge in the clinical management of tracheostomy patients. Little evidence is available to guide the weaning process and optimal timing of tracheostomy tube removal. The purpose of the study was to investigate the value of endoscopic assessment in the tracheostomy decannulation decision.
Results
The study included 154 tracheostomized adult patients. Bedside assessment was done for 112 patients, and the other 42 patients were deceased. The results of bedside assessment lead to successful decannulation in 18 patients (16%), while 94 patients (84%) were unfit for decannulation. The most common cause of unfitness was aspiration and poor swallowing in 41% of patients. The endoscopic assessment was done for 59 patients out of 94 patients that were unfit for decannulation; thirteen patients of them were fit for decannulation (22%). The final status of the patients before discharge was decannulated in 31 cases and 81 patients were discharged with a tracheostomy.
Conclusions
The results indicated the importance of endoscopic assessment in the decannulation decision of tracheostomized patients. A large proportion of patients who are unfit for decannulation by bedside assessment could be fit after endoscopic assessment. Endoscopic assessment is essential particularly in tracheostomized patients who have failed to achieve decannulation through conventional protocols.
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Tracheostomy decannulation methods and procedures for assessing readiness for decannulation in adults: a systematic scoping review. INT J EVID-BASED HEA 2020; 17:74-91. [PMID: 31162271 DOI: 10.1097/xeb.0000000000000166] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Despite the undisputable benefits of tracheostomy, it has been reported to have links with impaired communication, reduced quality of life and a risk of health complications such as bleeding, tracheal stenosis and in some cases resulting in mortality. There is a paucity of literature on tracheostomy decannulation methods and procedures, leaving the decision to expert opinion and institutional guidelines. This study aimed to map evidence on methods and procedures of tracheostomy decannulation in adults and assessment of readiness for decannulation, to reveal knowledge gaps and inform further research. We conducted a systematic search of peer reviewed and grey literature on PubMed/MEDLINE, Google Scholar, Union Catalogue of Theses and Dissertations via SABINET Online, World Cat Dissertations and Theses via OCLC, WHO library and governmental websites from 1985 to present. Following title screening, abstract and full article screening was performed by two independent reviewers guided by the eligibility criteria. Data from included studies were extracted, collated, summarized and synthesized into the following themes: assessment, removal, monitoring and definition of failure of decannulation. Quality of the included studies was assessed using the Mixed Methods Appraisal Tool version 2011. Twenty-five out of 51 screened articles were eligible for data extraction. There was wide variation in the assessment methods employed across and within similar patient groups. The common themes that emerged in the assessment for readiness for decannulation are informed consent, clinical stability, airway patency, physiological decannulation, swallowing assessment, level of consciousness, effectiveness of cough and clearance of secretions. In conclusion, the current body of evidence is inadequate and requires further research, particularly validation of different parameters used. A protocol approach to decannulation may be inappropriate but rather an algorithmic approach using validated parameters.
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Hernández Martínez G, Rodriguez ML, Vaquero MC, Ortiz R, Masclans JR, Roca O, Colinas L, de Pablo R, Espinosa MDC, Garcia-de-Acilu M, Climent C, Cuena-Boy R. High-Flow Oxygen with Capping or Suctioning for Tracheostomy Decannulation. N Engl J Med 2020; 383:1009-1017. [PMID: 32905673 DOI: 10.1056/nejmoa2010834] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
BACKGROUND When patients with a tracheostomy tube reach a stage in their care at which decannulation appears to be possible, it is common practice to cap the tracheostomy tube for 24 hours to see whether they can breathe on their own. Whether this approach to establishing patient readiness for decannulation leads to better outcomes than one based on the frequency of airway suctioning is unclear. METHODS In five intensive care units (ICUs), we enrolled conscious, critically ill adults who had a tracheostomy tube; patients were eligible after weaning from mechanical ventilation. In this unblinded trial, patients were randomly assigned either to undergo a 24-hour capping trial plus intermittent high-flow oxygen therapy (control group) or to receive continuous high-flow oxygen therapy with frequency of suctioning being the indicator of readiness for decannulation (intervention group). The primary outcome was the time to decannulation, compared by means of the log-rank test. Secondary outcomes included decannulation failure, weaning failure, respiratory infections, sepsis, multiorgan failure, durations of stay in the ICU and hospital, and deaths in the ICU and hospital. RESULTS The trial included 330 patients; the mean (±SD) age of the patients was 58.3±15.1 years, and 68.2% of the patients were men. A total of 161 patients were assigned to the control group and 169 to the intervention group. The time to decannulation was shorter in the intervention group than in the control group (median, 6 days [interquartile range, 5 to 7] vs. 13 days [interquartile range, 11 to 14]; absolute difference, 7 days [95% confidence interval, 5 to 9]). The incidence of pneumonia and tracheobronchitis was lower, and the duration of stay in the hospital shorter, in the intervention group than in the control group. Other secondary outcomes were similar in the two groups. CONCLUSIONS Basing the decision to decannulate on suctioning frequency plus continuous high-flow oxygen therapy rather than on 24-hour capping trials plus intermittent high-flow oxygen therapy reduced the time to decannulation, with no evidence of a between-group difference in the incidence of decannulation failure. (REDECAP ClinicalTrials.gov number, NCT02512744.).
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Affiliation(s)
- Gonzalo Hernández Martínez
- From Virgen de la Salud University Hospital (G.H.M., M.-L.R., L.C.) and the Research Unit, Medical Council (R.C.-B.), Toledo, Ramón y Cajal University Hospital (M.-C.V., R.P.) and Ciber Enfermedades Respiratorias, Health Institute Carlos III (O.R.), Madrid, Ciudad Real University Hospital and Ciudad Real University, Ciudad Real (R.O., M.-C.E.), Medical Research Mar Institute (J.-R.M.), the Critical Care Department, Autònoma de Barcelona University (J.-R.M., M.G.-A.), Del Mar University Hospital (J.-R.M., C.C.), Vall d'Hebron Research Institute (O.R.), and Vall d'Hebron University Hospital (O.R., M.G.A.), Barcelona, and Alcala University, Alcalá de Henares (R.P.) - all in Spain
| | - Maria-Luisa Rodriguez
- From Virgen de la Salud University Hospital (G.H.M., M.-L.R., L.C.) and the Research Unit, Medical Council (R.C.-B.), Toledo, Ramón y Cajal University Hospital (M.-C.V., R.P.) and Ciber Enfermedades Respiratorias, Health Institute Carlos III (O.R.), Madrid, Ciudad Real University Hospital and Ciudad Real University, Ciudad Real (R.O., M.-C.E.), Medical Research Mar Institute (J.-R.M.), the Critical Care Department, Autònoma de Barcelona University (J.-R.M., M.G.-A.), Del Mar University Hospital (J.-R.M., C.C.), Vall d'Hebron Research Institute (O.R.), and Vall d'Hebron University Hospital (O.R., M.G.A.), Barcelona, and Alcala University, Alcalá de Henares (R.P.) - all in Spain
| | - Maria-Concepción Vaquero
- From Virgen de la Salud University Hospital (G.H.M., M.-L.R., L.C.) and the Research Unit, Medical Council (R.C.-B.), Toledo, Ramón y Cajal University Hospital (M.-C.V., R.P.) and Ciber Enfermedades Respiratorias, Health Institute Carlos III (O.R.), Madrid, Ciudad Real University Hospital and Ciudad Real University, Ciudad Real (R.O., M.-C.E.), Medical Research Mar Institute (J.-R.M.), the Critical Care Department, Autònoma de Barcelona University (J.-R.M., M.G.-A.), Del Mar University Hospital (J.-R.M., C.C.), Vall d'Hebron Research Institute (O.R.), and Vall d'Hebron University Hospital (O.R., M.G.A.), Barcelona, and Alcala University, Alcalá de Henares (R.P.) - all in Spain
| | - Ramón Ortiz
- From Virgen de la Salud University Hospital (G.H.M., M.-L.R., L.C.) and the Research Unit, Medical Council (R.C.-B.), Toledo, Ramón y Cajal University Hospital (M.-C.V., R.P.) and Ciber Enfermedades Respiratorias, Health Institute Carlos III (O.R.), Madrid, Ciudad Real University Hospital and Ciudad Real University, Ciudad Real (R.O., M.-C.E.), Medical Research Mar Institute (J.-R.M.), the Critical Care Department, Autònoma de Barcelona University (J.-R.M., M.G.-A.), Del Mar University Hospital (J.-R.M., C.C.), Vall d'Hebron Research Institute (O.R.), and Vall d'Hebron University Hospital (O.R., M.G.A.), Barcelona, and Alcala University, Alcalá de Henares (R.P.) - all in Spain
| | - Joan-Ramon Masclans
- From Virgen de la Salud University Hospital (G.H.M., M.-L.R., L.C.) and the Research Unit, Medical Council (R.C.-B.), Toledo, Ramón y Cajal University Hospital (M.-C.V., R.P.) and Ciber Enfermedades Respiratorias, Health Institute Carlos III (O.R.), Madrid, Ciudad Real University Hospital and Ciudad Real University, Ciudad Real (R.O., M.-C.E.), Medical Research Mar Institute (J.-R.M.), the Critical Care Department, Autònoma de Barcelona University (J.-R.M., M.G.-A.), Del Mar University Hospital (J.-R.M., C.C.), Vall d'Hebron Research Institute (O.R.), and Vall d'Hebron University Hospital (O.R., M.G.A.), Barcelona, and Alcala University, Alcalá de Henares (R.P.) - all in Spain
| | - Oriol Roca
- From Virgen de la Salud University Hospital (G.H.M., M.-L.R., L.C.) and the Research Unit, Medical Council (R.C.-B.), Toledo, Ramón y Cajal University Hospital (M.-C.V., R.P.) and Ciber Enfermedades Respiratorias, Health Institute Carlos III (O.R.), Madrid, Ciudad Real University Hospital and Ciudad Real University, Ciudad Real (R.O., M.-C.E.), Medical Research Mar Institute (J.-R.M.), the Critical Care Department, Autònoma de Barcelona University (J.-R.M., M.G.-A.), Del Mar University Hospital (J.-R.M., C.C.), Vall d'Hebron Research Institute (O.R.), and Vall d'Hebron University Hospital (O.R., M.G.A.), Barcelona, and Alcala University, Alcalá de Henares (R.P.) - all in Spain
| | - Laura Colinas
- From Virgen de la Salud University Hospital (G.H.M., M.-L.R., L.C.) and the Research Unit, Medical Council (R.C.-B.), Toledo, Ramón y Cajal University Hospital (M.-C.V., R.P.) and Ciber Enfermedades Respiratorias, Health Institute Carlos III (O.R.), Madrid, Ciudad Real University Hospital and Ciudad Real University, Ciudad Real (R.O., M.-C.E.), Medical Research Mar Institute (J.-R.M.), the Critical Care Department, Autònoma de Barcelona University (J.-R.M., M.G.-A.), Del Mar University Hospital (J.-R.M., C.C.), Vall d'Hebron Research Institute (O.R.), and Vall d'Hebron University Hospital (O.R., M.G.A.), Barcelona, and Alcala University, Alcalá de Henares (R.P.) - all in Spain
| | - Raul de Pablo
- From Virgen de la Salud University Hospital (G.H.M., M.-L.R., L.C.) and the Research Unit, Medical Council (R.C.-B.), Toledo, Ramón y Cajal University Hospital (M.-C.V., R.P.) and Ciber Enfermedades Respiratorias, Health Institute Carlos III (O.R.), Madrid, Ciudad Real University Hospital and Ciudad Real University, Ciudad Real (R.O., M.-C.E.), Medical Research Mar Institute (J.-R.M.), the Critical Care Department, Autònoma de Barcelona University (J.-R.M., M.G.-A.), Del Mar University Hospital (J.-R.M., C.C.), Vall d'Hebron Research Institute (O.R.), and Vall d'Hebron University Hospital (O.R., M.G.A.), Barcelona, and Alcala University, Alcalá de Henares (R.P.) - all in Spain
| | - Maria-Del-Carmen Espinosa
- From Virgen de la Salud University Hospital (G.H.M., M.-L.R., L.C.) and the Research Unit, Medical Council (R.C.-B.), Toledo, Ramón y Cajal University Hospital (M.-C.V., R.P.) and Ciber Enfermedades Respiratorias, Health Institute Carlos III (O.R.), Madrid, Ciudad Real University Hospital and Ciudad Real University, Ciudad Real (R.O., M.-C.E.), Medical Research Mar Institute (J.-R.M.), the Critical Care Department, Autònoma de Barcelona University (J.-R.M., M.G.-A.), Del Mar University Hospital (J.-R.M., C.C.), Vall d'Hebron Research Institute (O.R.), and Vall d'Hebron University Hospital (O.R., M.G.A.), Barcelona, and Alcala University, Alcalá de Henares (R.P.) - all in Spain
| | - Marina Garcia-de-Acilu
- From Virgen de la Salud University Hospital (G.H.M., M.-L.R., L.C.) and the Research Unit, Medical Council (R.C.-B.), Toledo, Ramón y Cajal University Hospital (M.-C.V., R.P.) and Ciber Enfermedades Respiratorias, Health Institute Carlos III (O.R.), Madrid, Ciudad Real University Hospital and Ciudad Real University, Ciudad Real (R.O., M.-C.E.), Medical Research Mar Institute (J.-R.M.), the Critical Care Department, Autònoma de Barcelona University (J.-R.M., M.G.-A.), Del Mar University Hospital (J.-R.M., C.C.), Vall d'Hebron Research Institute (O.R.), and Vall d'Hebron University Hospital (O.R., M.G.A.), Barcelona, and Alcala University, Alcalá de Henares (R.P.) - all in Spain
| | - Cristina Climent
- From Virgen de la Salud University Hospital (G.H.M., M.-L.R., L.C.) and the Research Unit, Medical Council (R.C.-B.), Toledo, Ramón y Cajal University Hospital (M.-C.V., R.P.) and Ciber Enfermedades Respiratorias, Health Institute Carlos III (O.R.), Madrid, Ciudad Real University Hospital and Ciudad Real University, Ciudad Real (R.O., M.-C.E.), Medical Research Mar Institute (J.-R.M.), the Critical Care Department, Autònoma de Barcelona University (J.-R.M., M.G.-A.), Del Mar University Hospital (J.-R.M., C.C.), Vall d'Hebron Research Institute (O.R.), and Vall d'Hebron University Hospital (O.R., M.G.A.), Barcelona, and Alcala University, Alcalá de Henares (R.P.) - all in Spain
| | - Rafael Cuena-Boy
- From Virgen de la Salud University Hospital (G.H.M., M.-L.R., L.C.) and the Research Unit, Medical Council (R.C.-B.), Toledo, Ramón y Cajal University Hospital (M.-C.V., R.P.) and Ciber Enfermedades Respiratorias, Health Institute Carlos III (O.R.), Madrid, Ciudad Real University Hospital and Ciudad Real University, Ciudad Real (R.O., M.-C.E.), Medical Research Mar Institute (J.-R.M.), the Critical Care Department, Autònoma de Barcelona University (J.-R.M., M.G.-A.), Del Mar University Hospital (J.-R.M., C.C.), Vall d'Hebron Research Institute (O.R.), and Vall d'Hebron University Hospital (O.R., M.G.A.), Barcelona, and Alcala University, Alcalá de Henares (R.P.) - all in Spain
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Brenner MJ, Pandian V, Milliren CE, Graham DA, Zaga C, Morris LL, Bedwell JR, Das P, Zhu H, Lee Y. Allen J, Peltz A, Chin K, Schiff BA, Randall DM, Swords C, French D, Ward E, Sweeney JM, Warrillow SJ, Arora A, Narula A, McGrath BA, Cameron TS, Roberson DW. Global Tracheostomy Collaborative: data-driven improvements in patient safety through multidisciplinary teamwork, standardisation, education, and patient partnership. Br J Anaesth 2020; 125:e104-e118. [PMID: 32456776 DOI: 10.1016/j.bja.2020.04.054] [Citation(s) in RCA: 32] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2019] [Revised: 03/17/2020] [Accepted: 04/17/2020] [Indexed: 01/15/2023] Open
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22
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McGrath BA, Wallace S, Lynch J, Bonvento B, Coe B, Owen A, Firn M, Brenner MJ, Edwards E, Finch TL, Cameron T, Narula A, Roberson DW. Improving tracheostomy care in the United Kingdom: results of a guided quality improvement programme in 20 diverse hospitals. Br J Anaesth 2020; 125:e119-e129. [DOI: 10.1016/j.bja.2020.04.064] [Citation(s) in RCA: 39] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2019] [Revised: 03/17/2020] [Accepted: 04/17/2020] [Indexed: 11/26/2022] Open
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23
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Thomas AJ, Talbot E, Drewery H. Failure of standard tracheostomy decannulation criteria to detect suprastomal pathology. Anaesth Rep 2020; 8:67-70. [PMID: 33163965 DOI: 10.1002/anr3.12048] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/04/2020] [Indexed: 11/08/2022] Open
Abstract
Meeting established criteria for tracheostomy decannulation should improve success, although there will be a small proportion of patients with a tracheostomy who fail decannulation. Failure rates depend on patient characteristics and disparity between institutional practices and expert opinion. However, there are no widely accepted published failure rates, or agreement on the time-point at which failure is assessed. We present a patient who had evidence of readiness for decannulation, but had immediate failure due to extrinsic tracheal compression, which proved difficult to diagnose and required surgery to resolve. Capping the tracheostomy before decannulation may or may not have given rise to suspicion of potential failure and this practice requires further evaluation as it is not without risk. For subglottic, but suprastomal lesions, nasendoscopy is not of value. It is important to decannulate patients in a safe environment, preferably early in the day to allow post decannulation observations and interventions should they become necessary, and with the close involvement of the multi-professional team. This report illustrates the failure of our standard Tracheostomy decannulation criteria, and direct upper airway view to identify suprastomal tracheal pathology, and we discuss the potential for additional criteria which may have identified the issue before decannulation attempts.
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Affiliation(s)
- A J Thomas
- Critical Care Outreach Team The Royal London Hospital London UK
| | - E Talbot
- Speech and Language Therapy The Royal London Hospital London UK
| | - H Drewery
- Department of Anaesthetics The Royal London Hospital London UK
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24
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Cherney RL, Pandian V, Ninan A, Eastman D, Barnes B, King E, Miller B, Judkins S, Smith AE, Smith NM, Hanley J, Creutz E, Carlson M, Schneider KJ, Shever LL, Casper KA, Davidson PM, Brenner MJ. The Trach Trail: A Systems-Based Pathway to Improve Quality of Tracheostomy Care and Interdisciplinary Collaboration. Otolaryngol Head Neck Surg 2020; 163:232-243. [PMID: 32450771 DOI: 10.1177/0194599820917427] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
OBJECTIVE To implement a standardized tracheostomy pathway that reduces length of stay through tracheostomy education, coordinated care protocols, and tracking patient outcomes. METHODS The project design involved retrospective analysis of a baseline state, followed by a multimodal intervention (Trach Trail) and prospective comparison against synchronous controls. Patients undergoing tracheostomy from 2015 to 2016 (n = 60) were analyzed for demographics and outcomes. Trach Trail, a standardized care pathway, was developed with the Iowa Model of Evidence-Based Practice. Trach Trail implementation entailed monthly tracheostomy champion training at 8-hour duration and staff nurse didactics, written materials, and experiential learning. Trach Trail enrollment occurred from 2018 to 2019. Data on demographics, length of stay, and care outcomes were collected from patients in the Trach Trail group (n = 21) and a synchronous tracheostomy control group (n = 117). RESULTS Fifty-five nurses completed Trach Trail training, providing care for 21 patients placed on the Trach Trail and for synchronous control patients with tracheostomy who received routine tracheostomy care. Patients on the Trach Trail and controls had similar demographic characteristics, diagnoses, and indications for tracheostomy. In the Trach Trail group, intensive care unit length of stay was significantly reduced as compared with the control group, decreasing from a mean 21 days to 10 (P < .05). The incidence of adverse events was unchanged. DISCUSSION Introduction of the Trach Trail was associated with a reduction in length of stay in the intensive care unit. Realizing broader patient-centered improvement likely requires engaging respiratory therapists, speech language pathologists, and social workers to maximize patient/caregiver engagement. IMPLICATIONS FOR PRACTICE Standardized tracheostomy care with interdisciplinary collaboration may reduce length of stay and improve patient outcomes.
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Affiliation(s)
- Rebecca L Cherney
- University of Michigan Hospital and Health Center, Ann Arbor, Michigan, USA.,University of Michigan School of Nursing, Ann Arbor, Michigan, USA
| | | | - Ashly Ninan
- University of Michigan Hospital and Health Center, Ann Arbor, Michigan, USA.,Johns Hopkins School of Nursing, Baltimore, Maryland, USA
| | - Debra Eastman
- University of Michigan Hospital and Health Center, Ann Arbor, Michigan, USA
| | - Brian Barnes
- University of Michigan Hospital and Health Center, Ann Arbor, Michigan, USA
| | - Elizabeth King
- University of Michigan Hospital and Health Center, Ann Arbor, Michigan, USA
| | - Brianne Miller
- University of Michigan Hospital and Health Center, Ann Arbor, Michigan, USA
| | - Samantha Judkins
- University of Michigan Hospital and Health Center, Ann Arbor, Michigan, USA
| | - Alfred E Smith
- Global Tracheostomy Quality Improvement Collaborative, Raleigh, North Carolina, USA
| | - Nan M Smith
- Global Tracheostomy Quality Improvement Collaborative, Raleigh, North Carolina, USA
| | - Julie Hanley
- University of Michigan Hospital and Health Center, Ann Arbor, Michigan, USA
| | - Eileen Creutz
- University of Michigan Hospital and Health Center, Ann Arbor, Michigan, USA
| | - Megan Carlson
- University of Michigan Hospital and Health Center, Ann Arbor, Michigan, USA
| | - Kevin J Schneider
- Department of Otolaryngology-Head and Neck Surgery, University of Michigan Medical Center, Ann Arbor, Michigan, USA
| | - Leah L Shever
- University of Michigan Hospital and Health Center, Ann Arbor, Michigan, USA.,University of Michigan School of Nursing, Ann Arbor, Michigan, USA
| | - Keith A Casper
- Department of Otolaryngology-Head and Neck Surgery, University of Michigan Medical Center, Ann Arbor, Michigan, USA
| | | | - Michael J Brenner
- Global Tracheostomy Quality Improvement Collaborative, Raleigh, North Carolina, USA.,Department of Otolaryngology-Head and Neck Surgery, University of Michigan Medical Center, Ann Arbor, Michigan, USA
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25
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Sanchez-Guerrero JA, Guerlain J, Cebrià I Iranzo MÀ, Baujat B, Lacau St Guily J, Périé S. Expiratory airflow obstruction due to tracheostomy tube: A spirometric study in 50 patients. Clin Otolaryngol 2020; 45:703-709. [PMID: 32351009 DOI: 10.1111/coa.13561] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2018] [Revised: 04/02/2020] [Accepted: 04/26/2020] [Indexed: 11/30/2022]
Abstract
OBJECTIVES Tracheostomy is commonly used in intensive care units and in head and neck departments. Airway obstruction due to occluded cuffless tracheostomy tubes themselves remains unknown, although capping trials are commonly used before decannulation. The aim of this study was to evaluate the extent to which airway obstruction can be caused by occluded cuffless tubes in patients who underwent head and neck surgery. DESIGN Prospective Research Outcome. SETTINGS University teaching hospital. PARTICIPANTS Fifty patients requiring transient tracheostomy after head and neck surgery. MAIN OUTCOME MEASURES A flow-volume loop (FVL) through the mouth using a portable spirometer, with the occluded fenestrated cuffless tube, was measured before and immediately after decannulation, by obstructing the orifice of tracheostomy tube. The measurement of FVL recorded the forced vital capacity (FVC), forced expiratory volume in 1 second (FEV1 ), peak expiratory flow (PEF), forced expiratory flow at 50% of FVC, peak inspiratory flow (PIF) and forced inspiratory flow at 50% of FVC. RESULTS A statistically significant difference between all spirometric parameters was found. Mean PEF and PIF, respectively, increased from 2.8 to 4.5 L/s (P < .0001) and 2.3 to 2.7 L/s (P < .01) before and after decannulation, with a strong positive correlation (r = 0.7; P < .05). A mean expiratory (34%) and inspiratory (9%) airflow reduction was observed due to cannula. CONCLUSIONS Occluded cuffless tracheostomy tubes cause a dramatic airflow obstruction, mainly in the expiratory phase of FVL. This should be taken into account during capping trials.
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Affiliation(s)
- Jose Antonio Sanchez-Guerrero
- Department of Rehabilitation, Faculty of Medicine Sorbonne University, Hospital Tenon, Assistance Publique Hôpitaux Paris (APHP), Paris, France.,Department of Physiotherapy, University of Cardenal Herrera-CEU, CEU Universities, Valencia, Spain
| | - Joanne Guerlain
- Department of Otolaryngology Head Neck Surgery, Faculty of Medicine Sorbonne University, Hospital Tenon, Assistance Publique Hôpitaux Paris (APHP), Paris, France
| | - Maria Àngels Cebrià I Iranzo
- Department of Physical Therapy, University of Valencia and Hospital Universitarii Politecnic La Fe, Valencia, Spain
| | - Bertrand Baujat
- Department of Otolaryngology Head Neck Surgery, Faculty of Medicine Sorbonne University, Hospital Tenon, Assistance Publique Hôpitaux Paris (APHP), Paris, France
| | - Jean Lacau St Guily
- Department of Otolaryngology Head Neck Surgery, Faculty of Medicine Sorbonne University, Hospital Tenon, Assistance Publique Hôpitaux Paris (APHP), Paris, France.,Department of Otolaryngology Head Neck Surgery, Rothshild Fondation, Paris, France
| | - Sophie Périé
- Department of Otolaryngology Head Neck Surgery, Faculty of Medicine Sorbonne University, Hospital Tenon, Assistance Publique Hôpitaux Paris (APHP), Paris, France.,Department of Otolaryngology Head and Neck Surgery, COM CCF Maillot, Hartmann Clinic, Neuilly sur Seine, France
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Ross J, McMurray K, Cameron T, Lanteri C. Use of a Silicon Stoma Stent as an Interim Step in High-Risk Tracheostomy Decannulation. OTO Open 2019; 3:2473974X19836432. [PMID: 31236540 PMCID: PMC6572920 DOI: 10.1177/2473974x19836432] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2019] [Revised: 01/21/2019] [Accepted: 02/18/2019] [Indexed: 11/23/2022] Open
Abstract
Objective To describe use of a stoma stent to facilitate high-risk decannulation. Methods Retrospective chart review of 14 consecutive patients who received a stent from March 2013 to December 2016 at a quaternary health care service. Primary outcome measures were decannulation outcome and adverse events. Results Decannulation outcome: 12 of 14 patients had their tracheostomy tube (TT) removal facilitated by stent use. Patients had the stent for a median of 6 days (interquartile range, 49). Reasons for use included medical instability, risk of sputum retention, uncertain airway patency, and the need for ongoing airway access. All patients survived to discharge. One patient residing in the community has retained a stoma stent. Adverse events: One patient removed the stent on the day of insertion, necessitating reinsertion of the TT. Granulation tissue at the stoma site was seen in 2 patients. Discussion A tracheostoma will normally close within 48 hours following decannulation, which is problematic if TT reinsertion is required. By using the stent, reversal of decannulation becomes a simple ward-based procedure. In comparison to a TT, which is secured with ties, the stoma stent proved unsuitable for use in an agitated patient. Implications for Practice Decreasing total cannulation time is of benefit as patients with tracheostomy are subject to high rates of complications and adverse events. A stoma stent poses little risk and a low morbidity burden to the patient in comparison to alternative management.
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Affiliation(s)
- Jacqueline Ross
- Tracheostomy Review and Management Service, Australia.,Victorian Spinal Cord Service, Melbourne, Australia
| | - Kristy McMurray
- Tracheostomy Review and Management Service, Australia.,Ventilator Accommodation Support Service, Melbourne, Australia.,Australian Nursing Federation, Melbourne, Australia
| | - Tanis Cameron
- Tracheostomy Review and Management Service, Australia.,Department of Speech Pathology, Austin Health, Melbourne, Australia
| | - Celia Lanteri
- Department of Respiratory Medicine, Austin Health, Melbourne, Australia.,Institute of Breathing and Sleep, Austin Health, Melbourne, Australia
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28
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Trouillet JL, Collange O, Belafia F, Blot F, Capellier G, Cesareo E, Constantin JM, Demoule A, Diehl JL, Guinot PG, Jegoux F, L’Her E, Luyt CE, Mahjoub Y, Mayaux J, Quintard H, Ravat F, Vergez S, Amour J, Guillot M. Trachéotomie en réanimation : recommandations formalisées d’experts sous l’égide de la Société de réanimation de langue française (SRLF) et de la Société française d’anesthésie et de réanimation (SFAR), en collaboration avec la Société française de médecine d’urgence (SFMU) et la Société française d’otorhinolaryngologie (SFORL). MEDECINE INTENSIVE REANIMATION 2019. [DOI: 10.3166/rea-2018-0066] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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29
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Medeiros GCD, Sassi FC, Lirani-Silva C, Andrade CRFD. Critérios para decanulação da traqueostomia: revisão de literatura. Codas 2019; 31:e20180228. [DOI: 10.1590/2317-1782/20192018228] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2018] [Accepted: 02/20/2019] [Indexed: 11/22/2022] Open
Abstract
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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Trouillet JL, Collange O, Belafia F, Blot F, Capellier G, Cesareo E, Constantin JM, Demoule A, Diehl JL, Guinot PG, Jegoux F, L’Her E, Luyt CE, Mahjoub Y, Mayaux J, Quintard H, Ravat F, Vergez S, Amour J, Guillot M. Trachéotomie en réanimation. ANESTHÉSIE & RÉANIMATION 2018. [DOI: 10.1016/j.anrea.2018.08.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
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31
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Diaz-Ballve LP, Villalba DS, Andreu MF, Escobar MA, Morel-Vulliez G, Lebus JM, Rositi ES. Respiratory muscle strength and state of consciousness values measured prior to the decannulation in different levels of complexity. A longitudinal prospective case series study. Med Intensiva 2018; 43:270-280. [PMID: 29699834 DOI: 10.1016/j.medin.2018.02.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2017] [Revised: 02/15/2018] [Accepted: 02/25/2018] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To describe the variables related to effective cough capacity and the state of consciousness measured prior to decannulation and compare their measured values between the different areas of care such as the Intensive Care Unit (ICU), General ward and Mechanical Ventilation Weaning and Rehabilitation Centers (MVWRC). Secondarily analyze the evolution of patients once decannulated. DESIGN Case series, longitudinal and prospective. SCOPE Multicentric 31 ICUs (polyvalent) and 5 MVWRC. PATIENTS Tracheostomized adults prior to decannulation. MEASUREMENTS Maximum expiratory pressure, peak expiratory flow coughed (PEFC), Glasgow Coma Scale (GCS). RESULTS Two hundred and seven decannulated patients, 124 (60%) in ICU, 59 (28%) General ward and 24 (12%) in MVWRC. The PEFC presented differences between the patients (ICU 110 - 190 l/min versus MVWRC 167.5 - 232.5 l/min, p <.01). The GCS was different between General ward (9 -15) versus ICU (10-15) and MVWRC (12-15); p <.01 and p <.01, respectively. There were differences in the days of hospitalization (p <.01), days with tracheostomy (<0.01) and the number of patients referred at home (p =.02) between the different scenarios. CONCLUSION There are differences in the values of PEFC and GCS observed when decannulating between different areas. A considerable number of patients are decannulated with values of PEFC and maximum expiratory pressure below the suggested cut-off points as predictors of failure in the literature. No patient in our series was decanulated with an GCS <8, this reflects the importance that the treating team gives to the state of consciousness prior to decannulation.
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Affiliation(s)
- L P Diaz-Ballve
- Gabiente de Producción de Información Hospitalaria (GAPIH), Coordinación de Docencia e Investigación, Hospital Nacional Prof. Alejandro Posadas, El Palomar, Buenos Aires, Argentina.
| | - D S Villalba
- Coordinación de Docencia e Investigación, Clínica Basilea, Ciudad Autónoma de Buenos Aires, Argentina
| | - M F Andreu
- Servicio de Kinesiología, Hospital Donación Francisco Santojanni, Ciudad Autónoma de Buenos Aires, Argentina
| | - M A Escobar
- Servicio de Kinesiología Respiratoria, Centro del Parque, Ciudad Autónoma de Buenos Aires, Argentina
| | - G Morel-Vulliez
- Servicio de Kinesiología Respiratoria, Centro del Parque, Ciudad Autónoma de Buenos Aires, Argentina
| | - J M Lebus
- Servicio de Kinesiología Respiratoria, Centro del Parque, Ciudad Autónoma de Buenos Aires, Argentina; Servicio de Kinesiología, Clínica de La Sagrada Familia, Ciudad Autónoma de Buenos Aires, Argentina
| | - E S Rositi
- Servicio de Kinesiología Respiratoria, Centro del Parque, Ciudad Autónoma de Buenos Aires, Argentina; Unidad de Kinesiología, H.I.G.A: Petrona V. de Cordero, San Fernando, Buenos Aires, Argentina
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32
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Trouillet JL, Collange O, Belafia F, Blot F, Capellier G, Cesareo E, Constantin JM, Demoule A, Diehl JL, Guinot PG, Jegoux F, L'Her E, Luyt CE, Mahjoub Y, Mayaux J, Quintard H, Ravat F, Vergez S, Amour J, Guillot M. Tracheotomy in the intensive care unit: Guidelines from a French expert panel: The French Intensive Care Society and the French Society of Anaesthesia and Intensive Care Medicine. Anaesth Crit Care Pain Med 2018; 37:281-294. [PMID: 29559211 DOI: 10.1016/j.accpm.2018.02.012] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Tracheotomy is widely used in intensive care units, albeit with great disparities between medical teams in terms of frequency and modality. Indications and techniques are, however, associated with variable levels of evidence based on inhomogeneous or even contradictory literature. Our aim was to conduct a systematic analysis of the published data in order to provide guidelines. We present herein recommendations for the use of tracheotomy in adult critically ill patients developed using the grading of recommendations assessment, development and evaluation (GRADE) method. These guidelines were conducted by a group of experts from the French Intensive Care Society (Société de réanimation de langue française) and the French Society of Anesthesia and Intensive Care Medicine (Société francaise d'anesthésie réanimation) with the participation of the French Emergency Medicine Association (Société française de médecine d'urgence), the French Society of Otorhinolaryngology. Sixteen experts and two coordinators agreed to consider questions concerning tracheotomy and its practical implementation. Five topics were defined: indications and contraindications for tracheotomy in intensive care, tracheotomy techniques in intensive care, modalities of tracheotomy in intensive care, management of patients undergoing tracheotomy in intensive care, and decannulation in intensive care. The summary made by the experts and the application of GRADE methodology led to the drawing up of 8 formal guidelines, 10 recommendations, and 3 treatment protocols. Among the 8 formal guidelines, 2 have a high level of proof (Grade 1±) and 6 a low level of proof (Grade 2±). For the 10 recommendations, GRADE methodology was not applicable and instead 10 expert opinions were produced.
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Affiliation(s)
- Jean-Louis Trouillet
- Service de réanimation, groupe hospitalier Pitié-Salpêtrière, Assistance publique-Hôpitaux de Paris, 75013 Paris, France
| | - Olivier Collange
- Hôpitaux universitaires de Strasbourg, Nouvel Hôpital Civil, pôle d'anesthésie-réanimation chirurgicale, SAMU, SMUR, NHC, 1, place de l'Hôpital, 67000 Strasbourg, France; EA 3072, FMTS université de Strasbourg, 67000 Strasbourg, France.
| | - Fouad Belafia
- Inserm, U1046, intensive care unit and department of anesthesiology, research unit, university of Montpellier, Saint-Éloi hospital, Montpellier school of medicine, 34000 Montpellier, France
| | - François Blot
- Medical-surgical intensive care unit, Gustave-Roussy Cancer Campus, 94800 Villejuif, France
| | - Gilles Capellier
- EA3920, université de Franche-Comté, CHRU de Besançon, 25000 Besançon, France; Australian and New Zealand intensive care research centre, department of epidemiology and preventive medicine, Monash University Clayton, Australia
| | - Eric Cesareo
- SAMU de Lyon and department of emergency medicine, Hospices Civils de Lyon, Edouard-Herriot hospital, 69003 Lyon, France; Lyon Sud, school of medicine, university Lyon 1, 69600 Oullins, France
| | - Jean-Michel Constantin
- Department of preoperative medicine university hospital of Clermont-Ferrand, 63000 Clermont-Ferrand, France; EA-7281, R2D2, Auvergne University, 63000 Clermont-Ferrand, France
| | - Alexandre Demoule
- Inserm, UMRS1158 neurophysiologie respiratoire expérimentale et clinique Sorbonne Université, 75013 Paris France; AP-HP, groupe hospitalier Pitié-Salpêtrière Charles-Foix, service de pneumologie et réanimation médicale du département R3S, Sorbonne Université Paris, 75013 Paris, France
| | - Jean-Luc Diehl
- Medical ICU, Georges-Pompidou European Hospital, AP-HP, 75016 Paris, France; Inserm UMR-S1140 Paris Descartes University and Sorbonne Paris Cité, 75006 Paris, France
| | - Pierre-Grégoire Guinot
- Anaesthesiology and critical care department, Amiens University Hospital, place Victor-Pauchet, 80054 Amiens, France; Inserm, U1088, Jules-Verne University of Picardy, 80054 Amiens, France
| | - Franck Jegoux
- Service ORL et chirurgie cervico-maxillofaciale, CHU de Pontchaillou, rue H.-Le-Guilloux, 35033 Rennes cedex 9, France
| | - Erwan L'Her
- CeSim/LaTIM Inserm, UMR 1101, université de Bretagne Occidentale, rue Camille-Desmoulins, 29200 Brest cedex, France; Médecine intensive et réanimation CHRU de Brest, boulevard Tanguy-Prigent, 29200 Brest cedex, France
| | - Charles-Edouard Luyt
- Service de réanimation, groupe hospitalier Pitié-Salpêtrière, Assistance publique-Hôpitaux de Paris, 75013 Paris, France; Inserm, UMRS-1166, UPMC, université Paris 06, ICAN, institute of cardiometabolism and nutrition sorbonne universités, 75013 Paris, France
| | - Yazine Mahjoub
- Department of anesthesia and intensive care, Amiens-Picardie, university Hospital, 80054 Amiens, France
| | - Julien Mayaux
- Inserm, UMRS1158 neurophysiologie respiratoire expérimentale et clinique Sorbonne Université, 75013 Paris France; AP-HP, groupe hospitalier Pitié-Salpêtrière Charles-Foix, service de pneumologie et réanimation médicale du département R3S, Sorbonne Université Paris, 75013 Paris, France
| | - Hervé Quintard
- Réanimation médico-chirurgicale, hôpital Pasteur 2, CHU de Nice, 30, voie Romaine, 06000 Nice, France; CNRS, UMR 7275, IPMC, 06560 Sophia Antipolis Valbonne, France
| | - François Ravat
- Centre des brûlés, centre hospitalier St-Joseph et St-Luc, 20, quai Claude-Bernard, 69007 Lyon, France
| | - Sébastien Vergez
- ORL chirurgie cervicofaciale, CHU de Toulouse, Rangueil-Larrey, 24, chemin de Pouvourville, 31059 Toulouse cedex 9, France
| | - Julien Amour
- Département d'anesthésie et de réanimation chirurgicale, institut de cardiologie, groupe hospitalier Pitié-Salpêtrière, 47-83, boulevard de l'Hôpital, 75013 Paris, France
| | - Max Guillot
- EA 3072, FMTS université de Strasbourg, 67000 Strasbourg, France; Hôpitaux universitaires de Strasbourg, hôpital de Hautepierre, réanimation médicale, avenue Molière, 67200 Strasbourg, France.
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Trouillet JL, Collange O, Belafia F, Blot F, Capellier G, Cesareo E, Constantin JM, Demoule A, Diehl JL, Guinot PG, Jegoux F, L'Her E, Luyt CE, Mahjoub Y, Mayaux J, Quintard H, Ravat F, Vergez S, Amour J, Guillot M. Tracheotomy in the intensive care unit: guidelines from a French expert panel. Ann Intensive Care 2018; 8:37. [PMID: 29546588 PMCID: PMC5854567 DOI: 10.1186/s13613-018-0381-y] [Citation(s) in RCA: 47] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2017] [Accepted: 02/08/2018] [Indexed: 12/29/2022] Open
Abstract
Tracheotomy is widely used in intensive care units, albeit with great disparities between medical teams in terms of frequency and modality. Indications and techniques are, however, associated with variable levels of evidence based on inhomogeneous or even contradictory literature. Our aim was to conduct a systematic analysis of the published data in order to provide guidelines. We present herein recommendations for the use of tracheotomy in adult critically ill patients developed using the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) method. These guidelines were conducted by a group of experts from the French Intensive Care Society (Société de Réanimation de Langue Française) and the French Society of Anesthesia and Intensive Care Medicine (Société Francaise d'Anesthésie Réanimation) with the participation of the French Emergency Medicine Association (Société Française de Médecine d'Urgence), the French Society of Otorhinolaryngology. Sixteen experts and two coordinators agreed to consider questions concerning tracheotomy and its practical implementation. Five topics were defined: indications and contraindications for tracheotomy in intensive care, tracheotomy techniques in intensive care, modalities of tracheotomy in intensive care, management of patients undergoing tracheotomy in intensive care, and decannulation in intensive care. The summary made by the experts and the application of GRADE methodology led to the drawing up of 8 formal guidelines, 10 recommendations, and 3 treatment protocols. Among the 8 formal guidelines, 2 have a high level of proof (Grade 1+/-) and 6 a low level of proof (Grade 2+/-). For the 10 recommendations, GRADE methodology was not applicable and instead 10 expert opinions were produced.
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Affiliation(s)
- Jean Louis Trouillet
- Service de Réanimation, Groupe Hospitalier Pitié-Salpêtrière, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Olivier Collange
- Hôpitaux Universitaires de Strasbourg, Nouvel Hôpital Civil, Pôle d'Anesthésie-Réanimation Chirurgicale, SAMU, SMUR, NHC, 1 Place de l'Hôpital, 67000, Strasbourg, France.,EA 3072, FMTS, Université de Strasbourg, Strasbourg, France
| | - Fouad Belafia
- Intensive Care Unit and Department of Anesthesiology, Research Unit INSERM U1046, University of Montpellier Saint Eloi Hospital and Montpellier School of Medicine, Montpellier, France
| | - François Blot
- Medical-Surgical Intensive Care Unit, Gustave Roussy Cancer Campus, Villejuif, France
| | - Gilles Capellier
- CHRU Besançon 25000, EA3920 Université de Franche-Comté, Besançon, France.,Australian and New Zealand Intensive Care Research Centre, Department of Epidemiology and Preventive Medicine, Monash University, Clayton, Australia
| | - Eric Cesareo
- SAMU de Lyon and Department of Emergency Medicine, Hospices Civils de Lyon, Edouard Herriot Hospital, Lyon, France.,Lyon Sud School of Medicine, University Lyon 1, Oullins, France
| | - Jean-Michel Constantin
- Department of Preoperative Medicine, University Hospital of Clermont-Ferrand, Clermont-Ferrand, France.,R2D2, EA-7281, Auvergne University, Clermont-Ferrand, France
| | - Alexandre Demoule
- INSERM, UMRS1158 Neurophysiologie Respiratoire Expérimentale et Clinique; AP-HP, Groupe Hospitalier Pitié-Salpêtrière Charles Foix, Service de Pneumologie et Réanimation Médicale du Département R3S, Sorbonne Université, Paris, France
| | - Jean-Luc Diehl
- Medical ICU, AP-HP, Georges Pompidou European Hospital, Paris, France.,INSERM UMR-S1140, Paris Descartes University and Sorbonne Paris Cité, Paris, France
| | - Pierre-Grégoire Guinot
- Anaesthesiology and Critical Care Department, Amiens University Hospital, Place Victor Pauchet, 80054, Amiens, France.,INSERM U1088, Jules Verne University of Picardy, 80054, Amiens, France
| | - Franck Jegoux
- Service ORL et Chirurgie Cervico-maxillo-Faciale, CHU PONTCHAILLOU, Rue H. Le Guilloux, 35033, Rennes Cedex 9, France
| | - Erwan L'Her
- CeSim/LaTIM INSERM UMR 1101, Université de Bretagne Occidentale, Rue Camille Desmoulins, 29200, Brest Cedex, France.,Médecine Intensive et Réanimation, CHRU de Brest, Boulevard Tanguy Prigent, 29200, Brest Cedex, France
| | - Charles-Edouard Luyt
- Service de Réanimation, Groupe Hospitalier Pitié-Salpêtrière, Assistance Publique-Hôpitaux de Paris, Paris, France.,UPMC Université Paris 06, INSERM, UMRS-1166, ICAN Institute of Cardiometabolism and Nutrition, Sorbonne Universités, Paris, France
| | - Yazine Mahjoub
- Department of Anesthesia and Intensive Care, Amiens-Picardie University Hospital, Amiens, France
| | - Julien Mayaux
- INSERM, UMRS1158 Neurophysiologie Respiratoire Expérimentale et Clinique; AP-HP, Groupe Hospitalier Pitié-Salpêtrière Charles Foix, Service de Pneumologie et Réanimation Médicale du Département R3S, Sorbonne Université, Paris, France
| | - Hervé Quintard
- Réanimation médico chirurgicale Hôpital Pasteur 2 CHU de Nice, 30 voie romaine, 06000, Nice, France.,CNRS UMR 7275, IPMC Sophia Antipolis, Valbonne, France
| | - François Ravat
- Centre des brûlés, Centre Hospitalier St Joseph et St Luc, 20 quai Claude Bernard, 69007, Lyon, France
| | - Sebastien Vergez
- ORL Chirurgie Cervicofaciale, CHU Toulouse Rangueil-Larrey, 24 chemin de Pouvourville, 31059, Toulouse Cedex 9, France
| | - Julien Amour
- Département d'Anesthésie et de Réanimation Chirurgicale, Institut de Cardiologie, Groupe Hospitalier Pitié-Salpêtrière, 47-83 Boulevard de l'Hôpital, 75013, Paris, France
| | - Max Guillot
- EA 3072, FMTS, Université de Strasbourg, Strasbourg, France. .,Hôpitaux Universitaires de Strasbourg, Hôpital de Hautepierre, Réanimation Médicale, Avenue Molière, 67200, Strasbourg, France.
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34
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Ward E, Pandian V, Brenner MJ. The Primacy of Patient-Centered Outcomes in Tracheostomy Care. PATIENT-PATIENT CENTERED OUTCOMES RESEARCH 2017; 11:143-145. [DOI: 10.1007/s40271-017-0283-3] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Bonvento B, Wallace S, Lynch J, Coe B, McGrath BA. Role of the multidisciplinary team in the care of the tracheostomy patient. J Multidiscip Healthc 2017; 10:391-398. [PMID: 29066907 PMCID: PMC5644554 DOI: 10.2147/jmdh.s118419] [Citation(s) in RCA: 47] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
Tracheostomies are used to provide artificial airways for increasingly complex patients for a variety of indications. Patients and their families are dependent on knowledgeable multidisciplinary staff, including medical, nursing, respiratory physiotherapy and speech and language therapy staff, dieticians and psychologists, from a wide range of specialty backgrounds. There is increasing evidence that coordinated tracheostomy multidisciplinary teams can influence the safety and quality of care for patients and their families. This article reviews the roles of these team members and highlights the potential for improvements in care.
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Affiliation(s)
- Barbara Bonvento
- Acute Intensive Care Unit, University Hospital South Manchester, Manchester
| | - Sarah Wallace
- Acute Intensive Care Unit, University Hospital South Manchester, Manchester.,Royal College of Speech and Language Therapists, London, UK
| | - James Lynch
- Acute Intensive Care Unit, University Hospital South Manchester, Manchester
| | - Barry Coe
- Acute Intensive Care Unit, University Hospital South Manchester, Manchester
| | - Brendan A McGrath
- Acute Intensive Care Unit, University Hospital South Manchester, Manchester
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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.
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Affiliation(s)
- Ratender Kumar Singh
- Department of Critical Care Medicine, Sanjay Gandhi Post Graduate Institute of Medical Sciences (SGPGIMS), Raebareli Road, Lucknow, 226014 Uttar Pradesh India
| | - Sai Saran
- Department of Critical Care Medicine, Sanjay Gandhi Post Graduate Institute of Medical Sciences (SGPGIMS), Raebareli Road, Lucknow, 226014 Uttar Pradesh India
| | - Arvind K Baronia
- Department of Critical Care Medicine, Sanjay Gandhi Post Graduate Institute of Medical Sciences (SGPGIMS), Raebareli Road, Lucknow, 226014 Uttar Pradesh India
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37
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Perin C, Meroni R, Rega V, Braghetto G, Cerri CG. Parameters Influencing Tracheostomy Decannulation in Patients Undergoing Rehabilitation after severe Acquired Brain Injury (sABI). Int Arch Otorhinolaryngol 2017; 21:382-389. [PMID: 29018503 PMCID: PMC5629091 DOI: 10.1055/s-0037-1598654] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2016] [Accepted: 12/21/2016] [Indexed: 11/06/2022] Open
Abstract
Introduction
Tracheostomy weaning in patients who suffered a severe acquired brain injury is often a challenge and decannulation failures are not uncommon.
Objective
Our study objective is to describe the decannulation failure rate in patients undergoing rehabilitation following a severe acquired brain injury (sABI); to describe the factors associated with a successful tube weaning.
Methods
We conduct a retrospective analysis of charts, consecutively retrieved considering a 3-year window. Variables analyzed were: age, sex, body mass index (BMI), Glasgow Coma Scale (GCS), cause of hospitalization (stroke, trauma, cardiac arrest), date of the pathological event, gap between the index event and the first day of hospitalization, duration of Neurorehabilitation Ward hospitalization, comorbidities, chest morphological alteration, kind of tracheostomy tube used (overall dimension, cap, fenestration), SpO2, presentation and quantification of pulmonary secretion, maximal inspiratory pressure (MIP) and maximal expiratory pressure (MEP), respiratory frequency and pattern, cardiac frequency, presence of spontaneous cough, cough strength, and blood gas analysis.
Results
We analyzed 45 tracheostomised sABI patients following stroke, trauma, or cardiac arrest. The weaning success percentage was higher in Head Trauma patients and in patients presenting positive spontaneous cough. Failures seem to be associated with presence of secretions and anoxic brain damage. GCS seemed not related to the decannulation outcome.
Conclusions
Parameters that could be used as positive predictors of weaning are: mean expiratory pressure, presence of spontaneous cough, and cough strength. Provoked cough and GCS were not predictive of weaning success.
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Affiliation(s)
- Cecilia Perin
- Medicina e Chirurgia, Universita degli Studi di Milano-Bicocca Ringgold Standard Institution, Milano, Italy
| | - Roberto Meroni
- Medicina e Chirurgia, Universita degli Studi di Milano-Bicocca Ringgold Standard Institution, Milano, Italy
| | - Vincenzo Rega
- Riabilitazione Neurologica, Gruppo Ospedaliero San Donato Ringgold Standard Institution, Milano, Lombardia, Italy
| | - Giacomo Braghetto
- Medicina e Chirurgia, Universita degli Studi di Milano-Bicocca Ringgold Standard Institution, Milano, Italy
| | - Cesare Giuseppe Cerri
- Medicina e Chirurgia, Universita degli Studi di Milano-Bicocca Ringgold Standard Institution, Milano, Italy
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Mahmood K, Wahidi MM. The Changing Role for Tracheostomy in Patients Requiring Mechanical Ventilation. Clin Chest Med 2016; 37:741-751. [PMID: 27842753 DOI: 10.1016/j.ccm.2016.07.013] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Tracheostomy is performed in patients who require prolonged mechanical ventilation or have upper airway instability. Percutaneous tracheostomy with Ciaglia technique is commonly used and rivals the surgical approach. Percutaneous technique is associated with decreased risk of stomal inflammation, infection, and bleeding along with reduction in health resource utilization when performed at bedside. Bronchoscopy and ultrasound guidance improve the safety of percutaneous tracheostomy. Early tracheostomy decreases the need for sedation and intensive care unit stay but may be unnecessary in some patients who can be extubated later successfully. A multidisciplinary approach to tracheostomy care leads to improved outcomes.
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Affiliation(s)
- Kamran Mahmood
- Division of Pulmonary, Allergy and Critical Care Medicine, Department of Medicine, Duke University Medical Center, DUMC 102356, Durham, NC 27710, USA.
| | - Momen M Wahidi
- Division of Pulmonary, Allergy and Critical Care Medicine, Department of Medicine, Duke University Medical Center, DUMC 102356, Durham, NC 27710, USA
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Brunet J, Dufour-Trivini M, Sauneuf B, Terzi N. Gestion de la décanulation : quelle prise en charge pour le patient trachéotomisé ? MEDECINE INTENSIVE REANIMATION 2015. [DOI: 10.1007/s13546-014-1007-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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40
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Standardized CT protocols and nomenclature: better, but not yet there. Pediatr Radiol 2014; 44 Suppl 3:440-3. [PMID: 25304702 DOI: 10.1007/s00247-014-3096-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2014] [Revised: 06/16/2014] [Accepted: 06/18/2014] [Indexed: 10/24/2022]
Abstract
Radiation dose associated with CT is an important safety concern in patient care, especially in children. Technical advancements in multidetector-row CT scanner technology offer several advantages for clinical applications; these advancements have considerably increased CT utilization and enhanced the complexity of CT scanning protocols. Furthermore there are several scan manufacturers spearheading these technical advancements, leading to different commercial names causing confusion among the users, especially at imaging sites with scanners from different vendors. Several scientific studies and the National Council on Radiation Protection and Measurements (NCRP) have shown variation in CT radiation doses for same body region and similar scanning protocols. Therefore there is a need for standardization of scanning protocols and nomenclature of scan parameters. The following material reviews the status and challenges in standardization of CT scanning and nomenclature.
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41
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Yelverton JC, Nguyen JH, Wan W, Kenerson MC, Schuman TA. Effectiveness of a standardized education process for tracheostomy care. Laryngoscope 2014; 125:342-7. [DOI: 10.1002/lary.24821] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2014] [Revised: 06/10/2014] [Accepted: 06/13/2014] [Indexed: 11/08/2022]
Affiliation(s)
- Joshua C. Yelverton
- Department of Otolaryngology-Head and Neck Surgery; Virginia Commonwealth University; Richmond Virginia U.S.A
| | - Josephine H. Nguyen
- Department of Otolaryngology-Head and Neck Surgery; Virginia Commonwealth University; Richmond Virginia U.S.A
| | - Wen Wan
- Department of Biostatistics; Virginia Commonwealth University; Richmond Virginia U.S.A
| | - Michael C. Kenerson
- Department of Otolaryngology-Head and Neck Surgery; Virginia Commonwealth University; Richmond Virginia U.S.A
| | - Theodore A. Schuman
- Department of Otolaryngology-Head and Neck Surgery; Virginia Commonwealth University; Richmond Virginia U.S.A
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