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 |