Abstract
BackgroundTracheostomy decannulation decision is the major challenge in the clinical management of tracheostomy patients. Little evidence is available to guide the weaning process and optimal timing of tracheostomy tube removal. The purpose of the study was to investigate the value of endoscopic assessment in the tracheostomy decannulation decision.ResultsThe study included 154 tracheostomized adult patients. Bedside assessment was done for 112 patients, and the other 42 patients were deceased. The results of bedside assessment lead to successful decannulation in 18 patients (16%), while 94 patients (84%) were unfit for decannulation. The most common cause of unfitness was aspiration and poor swallowing in 41% of patients. The endoscopic assessment was done for 59 patients out of 94 patients that were unfit for decannulation; thirteen patients of them were fit for decannulation (22%). The final status of the patients before discharge was decannulated in 31 cases and 81 patients were discharged with a tracheostomy.ConclusionsThe results indicated the importance of endoscopic assessment in the decannulation decision of tracheostomized patients. A large proportion of patients who are unfit for decannulation by bedside assessment could be fit after endoscopic assessment. Endoscopic assessment is essential particularly in tracheostomized patients who have failed to achieve decannulation through conventional protocols.
Highlights
Tracheostomy decannulation decision is the major challenge in the clinical management of tracheostomy patients
Fiberoptic endoscopic evaluation of swallowing (FEES) has been proven to be a standardized dysphagia assessment tool, but its use in tracheostomy decannulation protocol with additional endoscopic subglottic and tracheal airway assessment is not firmly established in clinical practice and its use depend on clinical experience
The endoscopic assessment was done for 59 patients out of 94 patients that were unfit for decannulation by bedside assessment (63%)
Summary
Tracheostomy decannulation decision is the major challenge in the clinical management of tracheostomy patients. The purpose of the study was to investigate the value of endoscopic assessment in the tracheostomy decannulation decision. Decannulation of patients with a prolonged tracheostomy is not as straightforward as tube removal following temporary tracheostomy for acute upper airway obstruction. Fiberoptic endoscopic evaluation of swallowing (FEES) has been proven to be a standardized dysphagia assessment tool, but its use in tracheostomy decannulation protocol with additional endoscopic subglottic and tracheal airway assessment is not firmly established in clinical practice and its use depend on clinical experience. Few studies were done to explore the role of endoscopic assessment in tracheostomy decannulation decision accuracy [5, 9, 15, 16]
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