Skip to main content

Advertisement

Table 1 Characteristics of included studies

From: The practice of tracheostomy decannulation—a systematic review

Author Country Year of publication Type of study Category of patients Number of patients Age (years) Duration of MV (days) prior to decannulation Surgical/PCT Inclusion criteria Exclusion criteria
Graves A et al. [11] USA 1995 Prospective single centre Chronic neurological illness 20 58 44–54 NA 1. Ventilation for 4 weeks
2. Successfully weaned off for 48 h
3. Minute ventilation <10 L/min
4. RR <12
5. SaO2 >90% (0.4 FiO2)
NA
Bach et al. [12] USA 1996 Prospective single centre Chronic neurological illness 49 24–62 287–2224 NA Medically stable
Afebrile
N WBC counts
Not receiving IV antibiotics
Cognitively intact Not on narcotics/sedation
Peak cough flow (PCF)
PaO2 >60 mmHg
SaO2 >92%
N PaCO2 ± ventilation and use of manually/mechanically assisted coughing
NA
Ceriana et al. [8] Italy 2003 Prospective single centre Non-respiratory, 58%
Chronic respiratory failure, 40%
72 59–77 8–72 Mainly surgical Clinical stability
Absence of psychiatric disorders
Effective cough (MEP ≥40 cmH2O)
PaCO2 <60 mmHg
Adequate swallowing (evaluated by gag reflex or blue dye test)
No tracheal stenosis endoscopically
Spontaneous breathing ≥5 days.
NA
Leung et al. [19] Australia 2003 Retrospective single centre Respiratory, 35%
Neurological, 35%
Trauma, 17%
100 65 25 Surgical, 47
PCT, 53
Not mentioned NA
Tobin et al. [13] Australia 2008 Prospective single centre Medical, 40%
Surgical, 14%
Cardiothoracic, 25%
Neurosurgical, 23%
280 61.8 NA
However, 58 pts on prolonged MV
Surgical, 15
PCT, 85
Tolerate capping >24 h
Cough effective
(No need of suctioning).
Speech (with Passey–Muir valve).
NA
Stelfox et al. [24] USA 2008 Questionnaire-based study
Multicentre
(118 centres)
Stroke, 166(24)
Respiratory failure, 159(23)
Trauma, 168(24)
Abdominal aortic aneurysm, 182(27)
675 case scenarios NA NA
However, majority physicians were from acute care.
NA NA NA
Choate et al. [14] Australia 2009 Prospective single centre Medical, 190
Surgical, 362
Trauma, 429
981 35–77 9–25 Surgical, 77%
PCT, 23%
Weaned from ventilator
Normal gag reflex
Effective cough
Reason for TT resolved
Ability to swallow own secretions
SaO2 >90%
Tracheotomies by ENT surgeons were excluded
O Connor et al. [4] USA 2009 Retrospective
single centre
Pneumonia, 25
Aspiration pneumonia or pneumonitis, 25 AECOPD, 25
Septic shock, 25
135 74(36–91) 45 NA NA NA
Chan LYY et al. [15] Hong Kong 2010 Prospective single centre Neurosurgical patients 32 49–80 13.32 NA Hemodynamically stable
Body temp <38 °C
Inspired O2 ≤4 L/min
SpO2 >90%
Inability to produce voluntary cough on command
Full ventilator support
Upper airway obstruction confirmed by FOB
Fully alert and producing voluntary cough on command
Fenestrated TT in place
Marchese et al. [25] Italy 2010 Retrospective questionnaire based Multicentre study
(22 centres)
Acute respiratory failure, 24
COPD, 34
Neuromuscular diseases, 28
Surgical, 11
Thoracic dysmorphism, 4
OSAS, 2
719 50–78 Not mentioned.
Majority patients with chronic diseases
Surgical, 34%
PCT, 66%
NA NA
Budviewser et al. [20] Germany 2011 Retrospective single centre AECOPD, 63
Pneumonia, 38
Cardiac failure, 18
Sepsis, 8
ARDS, 7
384 60–74 38 PCT, 100% Tolerates TT capping >24–48 h
Tracheostomy retainer (TR) successfully inserted ≥1h
NA
Shrestha KK et al. [9] India 2012 Prospective single centre Severe head trauma (GCS <8) 118   NA NA NA.
Gradual vs. abrupt decannulation compared
NA
Warnecke T et al. [16] Germany 2013 Prospective single centre Neurologically ill patients, like stroke, ICH, GBS, meningoencephalitis 100   7–33 NA Weaned off ventilator
Assessment by CSE which includes:
Patient’s vigilance and compliance, cough, swallowing assessed by fibreoptic endoscopic evaluation (FESS) with FEES protocol steps. Each step to be passed for decannulation to be considered, like secretions, spontaneous swallows, cough, puree consistency and fluids.
NA
Kenneth B et al. [21] USA 2014 Retrospective single centre Critically ill obese BMI 41.9 ± 14.3 102   NA Surgical, 74%
PCT, 26%
Data missing—2
NA Malignancy or tracheostomies performed outside
Pandain V et al. [17] USA 2014 Prospective single centre NA 57   21 NA 1.TT size ≤4 preferably cuffless
2. Breathes comfortably with continuous finger occlusion of TT >1 min without trapping air, tolerate speaking valve during waking hours without distress, mobilize secretions
3. Suction frequency less than every 4 h
4. No sedation during capping
Not satisfying inclusion criteria
Guerlain J et al. [18] France 2015 Prospective single centre Postoperative head and neck cancer patients 56   Short-term (<3 days) Surgical, 100% NA NA
Pasqua et al. [22] Italy 2015 Retrospective single centre Respiratory (COPD, ILD, OSAS), 33
Cardiac, 10
Abdominal surgery, 4
Orthopaedic, 1
48   91.61–215.5 NA Clinical and hemodynamic stability
No evidence of sepsis
Expiratory muscle strength (MEP >50 cm H2O)
Absence of tracheal stenosis/granuloma
Normal deglutition
PaCO2 <50 mm Hg
PaO2/FiO2 >200
Absence of nocturnal oxyhemoglobin desaturation
Patient consent
NA
Cohen et al. [23] Israel 2016 Retrospective single centre Patients with ≥3 co-morbidities, 35% 49   10 PCT, 100% Maturation of TT stoma
Normal vital signs
Effective coughing
Normal swallowing
Positive leak test
Age <18 years
Complications during initial TT placement
Decannulation process completed outside institute