Merritt R M, Bent J P, Smith R J
Medical College of Georgia, Augusta 30912-4060, USA.
Laryngoscope. 1997 Jul;107(7):868-71. doi: 10.1097/00005537-199707000-00006.
Although numerous decannulation techniques have been reported, often involving costly sleep studies, repetitive laser procedures, and tracheotomy tube "downsizing," no established standard of care exists. We advocate the following simple, minimally invasive decannulation protocol. After excluding concomitant airway lesions, suprastomal granulation is removed transtomally by an endoscopically guided rongeur. A tracheotomy tube is then fashioned with a fenestration centered in the tracheal lumen. Decannulation occurs if the patient maintains adequate ventilation over a 12- to 24-hour observation period with the fenestrated tracheotomy capped. Over 18 months we prospectively followed 10 consecutive children presenting as potential decannulation candidates. Using the aforementioned technique, nine of 10 patients were successfully decannulated (average follow-up, 11.5 months). The postoperative capped fenestrated tracheotomy trial provides a realistic assessment of preparedness for decannulation. We recommend this protocol as a rapid, efficient, and cost-effective means of achieving decannulation.
尽管已有众多拔管技术被报道，这些技术往往涉及昂贵的睡眠研究、重复性激光手术以及气管切开套管“缩管”，但目前尚无既定的护理标准。我们倡导以下简单的微创拔管方案。在排除合并气道病变后，经内镜引导咬骨钳经造口处切除造口上肉芽组织。然后制作一个在气管腔内有开窗的气管切开套管。如果患者在带开窗气管切开套管封堵的12至24小时观察期内维持足够通气，则可进行拔管。在18个月的时间里，我们前瞻性地连续跟踪了10名表现为潜在拔管候选者的儿童。采用上述技术，10例患者中有9例成功拔管（平均随访11.5个月）。术后带封堵的开窗气管切开套管试验为拔管准备情况提供了实际评估。我们推荐该方案作为实现拔管的快速、高效且经济有效的方法。
