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BACKGROUND: Tracheostomy is a common surgical procedure performed on critically ill patients. However, little is known about how clinicians make decisions to decannulate patients, and whether similar decisions are made by respiratory therapists (RTs) and physicians.
METHODS: We performed a cross-sectional survey of RTs (n = 52) and physicians (n = 102) at 54 medical centers in North America, to characterize contemporary decannulation practices.
RESULTS: RTs and physicians rated ability to tolerate capping, secretions, cough effectiveness, and level of consciousness as the most important factors in the decannulation decision, with RTs placing greater emphasis on ability to tolerate capping and physicians on level of consciousness. In the clinical scenarios, RTs and physicians recommended decannulation with similar frequency (52% vs 55%, P = .54). Patients were most likely to be recommended for decannulation if they had a strong cough, scant thin secretions, required minimal supplemental oxygen, and were alert and interactive. In addition, RTs were more likely to recommend decannulation for patients who demonstrated an ability to tolerate tracheostomy tube capping for 72 hours and whose etiology of respiratory failure was chronic obstructive pulmonary disease. RTs preferred shorter time frames for defining decannulation failure than did physicians (median response 48 h vs 96 h, P = .02 for test of proportions). Both groups identified 2-5% (median response) as an acceptable rate of decannulation failure (P = .48 for test of proportions).
CONCLUSIONS: Important differences exist in the decannulation practices of North American RTs and physicians. Evidence-based tracheostomy guidelines are needed to facilitate the safe and effective management of patients with tracheostomies.
- critical care
- intensive care
- Correspondence: Henry Thomas Stelfox MD PhD, Department of Critical Care Medicine, University of Calgary, Foothills Medical Centre EG23A, 1403 29 Street NW, Calgary, Alberta T2N 2T9 Canada. E-mail: .
Dr Hess has disclosed relationships with Respironics, Impact, and Pari.
Drs Stelfox and Schmidt have disclosed no conflicts of interest.
Dr Hess presented a version of this paper at the OPEN FORUM of the 53rd International Respiratory Congress of the American Association for Respiratory Care, held December 1-4, 2007, in Orlando, Florida.
- Copyright © 2009 by Daedalus Enterprises Inc.