Aerodynamic measures of patients with tracheostomy capping before and after decannulation

Gamal Youssef,Kamal M Abdulla,Sahar S Khalil

doi:10.1186/s43163-022-00198-x

Abstract

BackgroundGradually stepped decannulation, such as capping with fenestrated tubes or tube downsizing, is likely to prolong the decannulation process. The purpose of the study is to determine the differences in laryngeal aerodynamic measures, expiratory peak flow, and dyspnea index when breathing through the upper airway before and after decannulation. The study recruited sixteen adult patients with a tracheostomy who were fit for decannulation. Measurement of peak flow rate, aerodynamic measures, and dyspnea index has been done at two settings: first during capping and second after decannulation by 2 h using finger support to close the stoma and prevent air leak.ResultsChanges in outcome measures after decannulation revealed a significant increase in peak flow rate, vital capacity, maximum phonation, and phonatory speech pressure level; the glottal resistance significantly decreased after decannulation. The dyspnea severity index scores improved from 22.35 during capping to 13.37 after decannulation.ConclusionsThe results of our study showed that tracheostomy tube capping causes a significant reduction in peak flow and aerodynamic measures which improved after tracheostomy decannulation.

Highlights

Stepped decannulation, such as capping with fenestrated tubes or tube downsizing, is likely to prolong the decannulation process
The study aimed to determine the differences in laryngeal aerodynamic measures, expiratory peak flow, and dyspnea index when breathing through the upper airway with an occluded cuffless fenestrated tracheostomy tube, and after decannulation
The study included sixteen adult patients with a tracheostomy who were fit for decannulation according to our institutional decannulation protocol [9]

Summary

Introduction

Stepped decannulation, such as capping with fenestrated tubes or tube downsizing, is likely to prolong the decannulation process. Intermediate step of decannulation, as tube capping with a fenestrated tube, depends on noninvasive checking of the upper airway patency. It starts by finger closure of the tracheostomy to redirect air through the vocal folds and upper airway, allowing breathing and phonation. If the patient passes finger occlusion test, gradual tube capping starts and the patient is observed for any signs of respiratory distress. Stepped decannulation such as capping with the use of fenestrated tubes or tube downsizing is likely to prolong the decannulation process [1]. The endoscopic protocol in tracheostomized patients could improve the tracheostomy

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