Thomas A J, Talbot E, Drewery H
Critical Care Outreach Team The Royal London Hospital London UK.
Speech and Language Therapy The Royal London Hospital London UK.
Anaesth Rep. 2020 Jun 30;8(1):67-70. doi: 10.1002/anr3.12048. eCollection 2020 Jan-Jun.
Meeting established criteria for tracheostomy decannulation should improve success, although there will be a small proportion of patients with a tracheostomy who fail decannulation. Failure rates depend on patient characteristics and disparity between institutional practices and expert opinion. However, there are no widely accepted published failure rates, or agreement on the time-point at which failure is assessed. We present a patient who had evidence of readiness for decannulation, but had immediate failure due to extrinsic tracheal compression, which proved difficult to diagnose and required surgery to resolve. Capping the tracheostomy before decannulation may or may not have given rise to suspicion of potential failure and this practice requires further evaluation as it is not without risk. For subglottic, but suprastomal lesions, nasendoscopy is not of value. It is important to decannulate patients in a safe environment, preferably early in the day to allow post decannulation observations and interventions should they become necessary, and with the close involvement of the multi-professional team. This report illustrates the failure of our standard Tracheostomy decannulation criteria, and direct upper airway view to identify suprastomal tracheal pathology, and we discuss the potential for additional criteria which may have identified the issue before decannulation attempts.
符合气管造口脱管标准的患者脱管成功率应会提高，尽管仍有一小部分气管造口患者脱管失败。失败率取决于患者特征以及机构实践与专家意见之间的差异。然而，目前尚无广泛接受的已发表失败率，也未就评估失败的时间点达成共识。我们报告一例患者，该患者有脱管准备的迹象，但因气管外部受压导致立即脱管失败，这种情况难以诊断，需要手术解决。在脱管前封堵气管造口可能会也可能不会引发对潜在失败的怀疑，而且这种做法并非毫无风险，需要进一步评估。对于声门下但造口上方的病变，鼻内镜检查并无价值。在安全环境中为患者进行脱管很重要，最好在当天早些时候进行，以便在必要时进行脱管后观察和干预，并且要有多专业团队的密切参与。本报告说明了我们标准的气管造口脱管标准以及直接上气道检查在识别造口上方气管病变方面的失败情况，我们还讨论了可能在尝试脱管前就识别出问题的其他标准的可能性。
