Removal of the tracheostomy tube in the aspirating spinal cord-injured patient.

STUDY DESIGN

Four related case reports, occurring within a 10-month time frame during 2001.

OBJECTIVES

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.

SETTING

Victorian Spinal Cord Service (VSCS), Austin Hospital, Melbourne, Australia.

METHODS

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.

RESULTS

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.

CONCLUSION

It is possible to safely decannulate aspirating spinal cord injured individuals in some instances, using a risk management approach.