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Research ArticleOriginal Research

Clinical Criteria for Tracheostomy Decannulation in Subjects with Acquired Brain Injury

Claudia Enrichi, Irene Battel, Cristiano Zanetti, Isabella Koch, Laura Ventura, Katie Palmer, Francesca Meneghello, Francesco Piccione, Simonetta Rossi, Marta Lazzeri, Maurizio Sommariva and Andrea Turolla
Respiratory Care July 2017, respcare.05470; DOI: https://doi.org/10.4187/respcare.05470
Claudia Enrichi
Fondazione Ospedale di Neuroriabilitazione, Istituto di Ricovero e Cura a Carattere Scientifico, San Camillo, Venice, Italy.
MSc
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  • For correspondence: [email protected]
Irene Battel
Fondazione Ospedale di Neuroriabilitazione, Istituto di Ricovero e Cura a Carattere Scientifico, San Camillo, Venice, Italy.
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Cristiano Zanetti
Fondazione Ospedale di Neuroriabilitazione, Istituto di Ricovero e Cura a Carattere Scientifico, San Camillo, Venice, Italy.
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Isabella Koch
Fondazione Ospedale di Neuroriabilitazione, Istituto di Ricovero e Cura a Carattere Scientifico, San Camillo, Venice, Italy.
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Laura Ventura
Dipartimento di Scienze Statistiche-Universita' di Padova, Padova, Italy.
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Katie Palmer
Fondazione Ospedale di Neuroriabilitazione, Istituto di Ricovero e Cura a Carattere Scientifico, San Camillo, Venice, Italy.
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Francesca Meneghello
Fondazione Ospedale di Neuroriabilitazione, Istituto di Ricovero e Cura a Carattere Scientifico, San Camillo, Venice, Italy.
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Francesco Piccione
Fondazione Ospedale di Neuroriabilitazione, Istituto di Ricovero e Cura a Carattere Scientifico, San Camillo, Venice, Italy.
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Simonetta Rossi
Fondazione Ospedale di Neuroriabilitazione, Istituto di Ricovero e Cura a Carattere Scientifico, San Camillo, Venice, Italy.
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Marta Lazzeri
Ospedale Niguarda Ca' Granda, Milan, Italy.
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Maurizio Sommariva
Ospedale Niguarda Ca' Granda, Milan, Italy.
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Andrea Turolla
Fondazione Ospedale di Neuroriabilitazione, Istituto di Ricovero e Cura a Carattere Scientifico, San Camillo, Venice, Italy.
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Abstract

BACKGROUND: Patients with acquired brain injury (ABI) often require long periods of having a tracheostomy tube for airway protection and prolonged mechanical ventilation. It has been recognized that fast and safe decannulation improves outcomes and facilitates the recovery process. Nevertheless, few studies have provided evidence for decannulation criteria, despite the high prevalence of ABI subjects with tracheostomies. The aim of our study was to assess which clinical parameters are the best predictors for decannulation in subjects with ABI.

METHODS: In this cross-sectional study, we recruited 74 consecutive ABI subjects (mean age 51.52 ± 16.76) with tracheostomy tubes. First, the subjects underwent the original decannulation assessment for cannula removal. Second, they underwent our experimental decannulation protocol. The experimental protocol included: voluntary cough (cough peak flow ≥160 L/min), reflex cough, tracheostomy tube capping (≥72 h), swallowing instrumental assessment (penetration aspiration scale ≤5), blue dye test, number of trachea suctions, endoscopic assessment of airway patency (lumen diameter ≥50%), saturation (SpO2 >95%), and level of consciousness evaluation (Glasgow coma scale ≥8). The reference standard was clinical removal of the tracheostomy tube within 48 h.

RESULTS: Parameters showing the highest values of sensitivity and specificity, respectively, were tracheostomy tube capping (80%, 100%), endoscopy assessment of airway patency (100%, 30%), swallowing instrumental assessment (85%, 96%), and the blue dye test (65%, 85%). All these were combined in a clinical cluster parameter, which had higher sensitivity (100%) and specificity (82%).

CONCLUSION: These results suggest that the best clinical prediction rule for decannulation in acquired brain injury subjects is a combination of the following assessments: (1) tracheostomy tube capping, (2) endoscopic assessment of patency of airways, (3) swallowing instrumental assessment, and (4) blue dye test.

  • acquired brain injury
  • tracheostomy tube
  • decannulation protocol
  • weaning protocol
  • dysphagia
  • voluntary cough
  • reflex cough
  • blue dye test
  • airways patency
  • tracheostomy tube capping

Footnotes

  • Correspondence: Claudia Enrichi, Fondazione Ospedale di Neuroriabilitazione IRCCS San Camillo, Via Alberoni n° 70, postcode 30126, Venice, Italy. E-mail: claudia.enrichi{at}ospedalesancamillo.net.
  • The authors have disclosed no conflicts of interest.

  • Copyright © 2017 by Daedalus Enterprises
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Respiratory Care: 68 (10)
Respiratory Care
Vol. 68, Issue 10
1 Oct 2023
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Clinical Criteria for Tracheostomy Decannulation in Subjects with Acquired Brain Injury
Claudia Enrichi, Irene Battel, Cristiano Zanetti, Isabella Koch, Laura Ventura, Katie Palmer, Francesca Meneghello, Francesco Piccione, Simonetta Rossi, Marta Lazzeri, Maurizio Sommariva, Andrea Turolla
Respiratory Care Jul 2017, respcare.05470; DOI: 10.4187/respcare.05470

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Clinical Criteria for Tracheostomy Decannulation in Subjects with Acquired Brain Injury
Claudia Enrichi, Irene Battel, Cristiano Zanetti, Isabella Koch, Laura Ventura, Katie Palmer, Francesca Meneghello, Francesco Piccione, Simonetta Rossi, Marta Lazzeri, Maurizio Sommariva, Andrea Turolla
Respiratory Care Jul 2017, respcare.05470; DOI: 10.4187/respcare.05470
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Keywords

  • acquired brain injury
  • tracheostomy tube
  • decannulation protocol
  • weaning protocol
  • dysphagia
  • voluntary cough
  • reflex cough
  • blue dye test
  • airways patency
  • tracheostomy tube capping

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