University of Ottawa, Ottawa, ON, Canada.
Am J Phys Med Rehabil. 2012 Aug;91(8):666-70. doi: 10.1097/PHM.0b013e31825597b8.
The aim of this study was to examine the relationship between cough peak flows (CPFs) before and after tracheostomy tube removal (decannulation) in patients with neuromuscular respiratory muscle weakness.
For 26 patients with occluded tracheostomies (capped or Passy-Muir valve), spontaneous CPF (CPF(sp)), CPF after lung volume recruitment (CPF(LVR)), and CPF after lung volume recruitment and a manually assisted cough (CPF(LVR) + MAC) were measured before and after decannulation.
Decannulation resulted in a significant increase (P < 0.001) in CPF of 35.6, 34.5, and 42.6 l/min for CPF(sp), CPF(LVR), and CPF(LVR) + MAC, respectively. In addition, CPF(LVR) or CPF(LVR) + MAC with a capped tracheostomy in place were greater than spontaneous CPF with the tracheostomy tube removed.
Our study suggests that assisted coughing with a capped tracheostomy tube in place can result in higher flows than removing the tube and relying on spontaneous cough alone. Postdecannulation CPF measured at the mouth can be predicted to be at least 34.5 l/min greater than predecannulation values, which may thereby lower the threshold of the CPF indicated for safe decannulation.
本研究旨在探讨神经肌肉呼吸肌无力患者在气管造口管（带管或 Passy-Muir 阀）拔除前后咳嗽峰流速（CPF）之间的关系。
对 26 例气管造口管堵塞（带管或 Passy-Muir 阀）患者，分别在拔管前和拔管后测量自发 CPF（CPF(sp)）、肺容积复张后 CPF（CPF(LVR)）和肺容积复张后加手动辅助咳嗽 CPF（CPF(LVR) + MAC）。
拔管后 CPF(sp)、CPF(LVR)和 CPF(LVR) + MAC 分别显著增加（P<0.001）35.6、34.5 和 42.6 l/min。此外，带管时的 CPF(LVR)或 CPF(LVR) + MAC 大于拔管时的自发 CPF。
我们的研究表明，与单独拔管和依靠自发咳嗽相比，带管的辅助咳嗽可以产生更高的流量。拔管后口测 CPF 可预测至少比拔管前增加 34.5 l/min，从而降低安全拔管所需 CPF 的阈值。
