Abstract
To perform a literature review on the existing international criteria and protocols for tracheostomy decannulation. strategies: Literature review using the PubMed database with the English keywords "Tracheostomy", "Weaning", "Decannulation", "Removal Tube", "Speech, Language and Hearing Sciences", "Intensive Care Units", "Dysphagia", "Swallowing", "Deglutition" and "Deglutition Disorders ". Studies published in the last five years (2012 to 2017); studies with human adult population (i.e. ages above 18 years); articles published in English; unrestricted full access articles; and research related to the objectives of the study. we analyzed sample characterization; professionals involved in the decannulation process; steps of the decannulation process; total time in days of tracheostomy use; total time in days to complete decannulation process; and failure factors to complete the decannulation process. Most of the studies investigated tracheostomy decannulation in a sample of males with neurological impairments. The professionals involved in the decannulation process were doctors, speech therapists, physiotherapists and nurses. The most cited decannulation steps were: swallowing assessment; occlusion training; evaluation of air permeability; ability to manipulate secretion and exchange of cannula; cuff deflation and cough training; use of speech valve. Speech therapists are of great help during the decannulation process, since the assessment of swallowing was one of the decisive steps of the investigated studies. The processes of decannulation includes a multidisciplinary approach and should be performed by the cooperation between physicians, physiotherapists and speech therapists.
Highlights
Invasive mechanical ventilation or assisted ventilation is one of the most common procedures used in intensive care units (ICUs)(1) to treat patients with acute or chronic acute respiratory failure, aiding in gas exchange maintenance, respiratory muscle work, and decreased oxygen use(2)
Two studies showed the participation of occupational therapists in the process of decannulation, and two studies showed the participation of psychologists(18,25) among the professionals(17,25)
We found that 14 articles used objective examinations in the decannulation process, having five studies using nasolaringofibroscopia(11,18,20,22,31), four using broncoscopia(20,27,28,35), two using tomography(18,36) and three studies using swallowing videoendoscopy(15,18,26)
Summary
Invasive mechanical ventilation or assisted ventilation is one of the most common procedures used in intensive care units (ICUs)(1) to treat patients with acute or chronic acute respiratory failure, aiding in gas exchange maintenance, respiratory muscle work, and decreased oxygen use(2). This assisted ventilation support has reduced the mortality of critically ill patients over the decades, resulting in the conversion of many lethal conditions(3). Changes in swallowing biomechanics associated with tracheostomy include reduction in laryngeal elevation, resulting in insufficient airway closure, external cuff pressure in the esophagus, causing difficulty in the passage of the food bolus, less subglottic pressure, increased occurrence of stasis in the supraglottic region, reduced cough reflex, decreased airway protection, reduced vocal fold adduction reflex, causing slowness and incoordination in their closure(13)
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