The low value of pre-decannulation capped overnight ICU monitoring for pediatric patients

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.

Physical condition, activity pattern, and environment as factors in falls by adult care facility residents

This study surveyed 294 fall incident reports made over a three-year period concerning 95 residents in an adult care facility. We determined the frequencies of fall location, time of day or night, and assessed the precipitating factors from fall descriptions made by residents and/or their care givers. We found that 57% of the falls occurred in the residents' rooms, with private or shared bathrooms as the next most frequent locus. Precipitating factors were surveyed; 50.3% of the fall descriptions implicated environmental features (pieces of furniture were most frequently mentioned), the physical condition of the resident contributed to 24.3% of the falls, and specific physical activities were implicated in 7.9% of the falls. Multiple factors accounted for 6.5% of the total falls. In 17% of the cases, no clear indication of cause was found. Unsafe environments have been implicated as a fall risk factor. Despite adaptations to lessen environmental hazards, a large number of reportable falls occurred in this facility, which was for elderly individuals who were in relatively good health commensurate with their age.

A portable, easily performed muscle power test and its association with falls by elderly persoms

This study developed and evaluated a simple, inexpensive, and safe screening test for assessment of falling risk in elderly persons. Subjects sat in chairs (hips and knees at 90 degrees) with their feet over a force transducer and stood as forcefully as possible. After standing for five seconds, they sat as fast as possible. The rate of change in force (dF/dT) for standing and sitting were calculated from data collected by computer. A group of nonfallers (n = 23, age = 23 to 72 years) and a group of fallers (n = 22, age = 63 to 92 years) were studied. Nonfallers' dF/dT for standing decreased linearly from 4kg.sec-1.kg-1 to 2.5kg.sec-1.kg-1. Values in fallers decreased linearly from 3kg.sec-1.kg-1 to 0.1kg.sec-1.kg-1. The dF/dT for sitting was not dependent on age in either group. Fallers had lower dF/dT than nonfallers (1.3 +/- .6kg.sec-1.kg-1 and 2.3 +/- .01kg.sec-1.kg-1, respectively). Seventeen of 22 fallers were identified by a reduced dF/dT and reduced overshoot force (kg).