1Department of Otorhinolaryngology Head & Neck Surgery 2Department of Nursing and Public Health, University of KwaZulu-Natal, Durban, South Africa 3Institute of Clinical Experimental Research, Semmelweis University, Budapest, Hungary 4Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA.
Int J Evid Based Healthc. 2019 Jun;17(2):74-91. doi: 10.1097/XEB.0000000000000166.
Despite the undisputable benefits of tracheostomy, it has been reported to have links with impaired communication, reduced quality of life and a risk of health complications such as bleeding, tracheal stenosis and in some cases resulting in mortality. There is a paucity of literature on tracheostomy decannulation methods and procedures, leaving the decision to expert opinion and institutional guidelines. This study aimed to map evidence on methods and procedures of tracheostomy decannulation in adults and assessment of readiness for decannulation, to reveal knowledge gaps and inform further research. We conducted a systematic search of peer reviewed and grey literature on PubMed/MEDLINE, Google Scholar, Union Catalogue of Theses and Dissertations via SABINET Online, World Cat Dissertations and Theses via OCLC, WHO library and governmental websites from 1985 to present. Following title screening, abstract and full article screening was performed by two independent reviewers guided by the eligibility criteria. Data from included studies were extracted, collated, summarized and synthesized into the following themes: assessment, removal, monitoring and definition of failure of decannulation. Quality of the included studies was assessed using the Mixed Methods Appraisal Tool version 2011. Twenty-five out of 51 screened articles were eligible for data extraction. There was wide variation in the assessment methods employed across and within similar patient groups. The common themes that emerged in the assessment for readiness for decannulation are informed consent, clinical stability, airway patency, physiological decannulation, swallowing assessment, level of consciousness, effectiveness of cough and clearance of secretions. In conclusion, the current body of evidence is inadequate and requires further research, particularly validation of different parameters used. A protocol approach to decannulation may be inappropriate but rather an algorithmic approach using validated parameters.
尽管气管切开术有其不可否认的好处，但它已被报道与交流障碍、生活质量下降以及出血、气管狭窄等健康并发症风险有关，在某些情况下甚至会导致死亡。关于气管切开术拔管方法和程序的文献很少，这使得决策取决于专家意见和机构指南。本研究旨在绘制成人气管切开术拔管方法和程序的证据图，并评估拔管准备情况，以揭示知识空白并为进一步研究提供信息。我们在 PubMed/MEDLINE、Google Scholar、SABINET Online 的联合论文目录、WorldCat Dissertations and Theses via OCLC、WHO 图书馆和政府网站上进行了系统搜索，检索时间为 1985 年至今。在标题筛选后，由两名独立审查员根据纳入标准进行摘要和全文筛选。从纳入研究中提取、整理、总结和综合数据，总结为以下主题：评估、移除、监测和拔管失败的定义。使用混合方法评估工具 2011 版评估纳入研究的质量。在筛选出的 51 篇文章中，有 25 篇符合数据提取标准。评估拔管准备情况的方法在不同患者群体之间和内部存在广泛差异。在评估拔管准备情况时出现的共同主题包括知情同意、临床稳定、气道通畅、生理拔管、吞咽评估、意识水平、咳嗽效果和分泌物清除。总之，目前的证据不足，需要进一步研究，特别是对不同参数的验证。拔管的方案方法可能不合适，而使用经过验证的参数的算法方法可能更合适。
