Ross J, White M
Physiotherapy Department, Austin Hospital, Melbourne, Australia.
Spinal Cord. 2003 Nov;41(11):636-42. doi: 10.1038/sj.sc.3101510.
Four related case reports, occurring within a 10-month time frame during 2001.
Aspiration is commonly reported in the literature as a contraindication to decannulation. We report four examples of successful removal of the tracheostomy tube in the presence of aspiration by an experienced team, utilising a risk management approach.
Victorian Spinal Cord Service (VSCS), Austin Hospital, Melbourne, Australia.
Four individuals in our unit with traumatic spinal cord injury, three quadriplegic and one paraplegic, presented with aspiration identified by a positive modified Evan's blue dye test or constant coughing, gagging and oxygen desaturation during cuff deflation trials. In three of the four cases, the tracheostomy tube had been in situ for a prolonged period and the patients had failed to progress towards decannulation. A decision was made to decannulate these four patients in spite of the presence of traditionally held contraindications for decannulation. The multidisciplinary team carefully compared the inherent risks of premature decannulation against those of prolonged tracheostomisation. Given the risk associated with this procedure, a closely monitored decannulation protocol was instituted.
All four patients were successfully decannulated with improved quality of life, eating between 1 and 4 days and communicating immediately after decannulation. None experienced respiratory deterioration.
It is possible to safely decannulate aspirating spinal cord injured individuals in some instances, using a risk management approach.
4例相关病例报告，发生在2001年10个月的时间范围内。
文献中普遍将误吸报告为拔管的禁忌证。我们报告了4例由经验丰富的团队在存在误吸的情况下成功拔除气管造口管的案例，采用了风险管理方法。
澳大利亚墨尔本奥斯汀医院的维多利亚脊髓服务中心（VSCS）。
我们科室的4例创伤性脊髓损伤患者，3例四肢瘫痪，1例截瘫，通过改良伊文氏蓝染料试验阳性或在气囊放气试验期间持续咳嗽、 gagging和氧饱和度下降确定有误吸。在4例中的3例中，气管造口管已留置很长时间，患者在拔管方面未取得进展。尽管存在传统的拔管禁忌证，但仍决定对这4例患者进行拔管。多学科团队仔细比较了过早拔管与长期气管造口的固有风险。鉴于该手术的风险，制定了密切监测的拔管方案。
所有4例患者均成功拔管，生活质量得到改善，拔管后1至4天内进食，拔管后立即能够交流。无一例出现呼吸恶化。
在某些情况下，采用风险管理方法可以安全地为有误吸的脊髓损伤患者拔管。
