Devaraja K, Majitha C S, Pujary Kailesh, Nayak Dipak Ranjan, Rao Shwethapriya
Department of Otorhinolaryngology and Head and Neck Surgery, Kasturba Medical College, Manipal Academy of Higher Education, Manipal, Karnataka, India.
Department of Critical Care Medicine, Kasturba Medical College, Manipal Academy of Higher Education, Manipal, Karnataka, India.
Int Arch Otorhinolaryngol. 2024 Feb 5;28(2):e211-e218. doi: 10.1055/s-0043-1776720. eCollection 2024 Apr.
The criteria for the removal of the tracheostomy tube (decannulation) vary from center to center. Some perform an endoscopic evaluation under anesthesia or computed tomography, which adds to the cost and discomfort. We use a simple two-part protocol to determine the eligibility and carry out the decannulation: part I consists of airway and swallowing assessment through an office-based flexible laryngotracheoscopy, and part II involves a tracheostomy capping trial. The primary objective was to determine the safety and efficacy of the simplified decannulation protocol followed at our center among the patients who were weaned off the mechanical ventilator and exhibited good swallowing function clinically. Of the patients considered for decannulation between November 1st, 2018, and October 31st, 2020, those who had undergone tracheostomy for prolonged mechanical ventilation were included. The efficacy to predict successful decannulation was calculated by the decannulation rate among patients who had been deemed eligible for decannulation in part I of the protocol, and the safety profile was defined by the protocol's ability to correctly predict the chances of risk-free decannulation among those submitted to part II of the protocol. Among the 48 patients included (mean age: 46.5 years; male-to-female ratio: 3:1), the efficacy of our protocol in predicting the successful decannulation was of 87.5%, and it was was safe or reliable in 95.45%. Also, in our cohort, the decannulation success and the duration of tracheotomy dependence were significantly affected by the neurological status of the patients. The decannulation protocol consisting of office-based flexible laryngotracheoscopy and capping trial of the tracheostomy tube can safely and effectively aid the decannulation process.
气管造口管拔除（脱管）的标准因中心而异。有些中心在麻醉或计算机断层扫描下进行内镜评估，这增加了成本和患者的不适感。我们采用一个简单的两部分方案来确定脱管的适宜性并实施脱管：第一部分包括通过门诊柔性喉镜进行气道和吞咽评估，第二部分涉及气管造口管封堵试验。
主要目的是确定我们中心遵循的简化脱管方案在已停用机械通气且临床上吞咽功能良好的患者中的安全性和有效性。
在2018年11月1日至2020年10月31日期间考虑进行脱管的患者中，纳入了因长期机械通气而接受气管造口术的患者。通过该方案第一部分中被认为适合脱管的患者的脱管率来计算预测成功脱管的有效性，安全性则通过该方案正确预测接受该方案第二部分患者无风险脱管几率的能力来定义。
在纳入的48例患者中（平均年龄：46.5岁；男女比例：3:1），我们的方案预测成功脱管的有效性为87.5%，安全性或可靠性为95.45%。此外，在我们的队列中，脱管成功与否以及气管切开依赖的持续时间受患者神经状态的显著影响。
由门诊柔性喉镜检查和气管造口管封堵试验组成的脱管方案能够安全有效地辅助脱管过程。
