Determinants of tracheostomy decannulation: an international survey.
BACKGROUND
Although tracheostomy is probably the most common surgical procedure performed on critically ill patients, it is unknown when a tracheostomy tube can be safely removed.


METHODS
We performed a cross-sectional survey of physicians and respiratory therapists with expertise in the management of tracheostomized patients at 118 medical centers to characterize contemporary opinions about tracheostomy decannulation practice and to define factors that influence these practices.


RESULTS
We surveyed 309 clinicians, of whom 225 responded (73%). Clinicians rated patient level of consciousness, ability to tolerate tracheostomy tube capping, cough effectiveness, and secretions as the most important factors in the decision to decannulate a patient. Decannulation failure was defined as the need to reinsert an artificial airway within 48 hours (45% of respondents) to 96 hours (20% of respondents) of tracheostomy removal, and 2% to 5% was the most frequent recommendation for an acceptable recannulation rate (44% of respondents). In clinical scenarios, clinicians who worked in chronic care facilities (30%) were less likely to recommend decannulation than clinicians who worked in weaning (47%), rehabilitation (53%), or acute care (55%) facilities (p = 0.015). Patients were most likely to be recommended for decannulation if they were alert and interactive (odds ratio [OR] 4.76, 95% confidence interval [CI] 3.27 to 6.90; p < 0.001), had a strong cough (OR 3.84, 95% CI 2.66 to 5.54; p < 0.001), had scant thin secretions (OR 2.23, 95% CI 1.56 to 3.19; p < 0.001), and required minimal supplemental oxygen (OR 2.04, 95% CI 1.45 to 2.86; p < 0.001).


CONCLUSIONS
Patient level of consciousness, cough effectiveness, secretions, and oxygenation are important determinants of clinicians' tracheostomy decannulation opinions. Most surveyed clinicians defined decannulation failure as the need to reinsert an artificial airway within 48 to 96 hours of planned tracheostomy removal.
Stelfox
Henry Thomas
HT
Department of Critical Care Medicine, University of Calgary, Foothills Medical Centre, EG23A, 1403-29 Street NW, Calgary, AB, Canada, T2N 2T9. tom.stelfox@calgaryhealthregion.ca
Crimi
Claudia
C
Berra
Lorenzo
L
Noto
Alberto
A
Schmidt
Ulrich
U
Bigatello
Luca M
LM
Hess
Dean
D
D003243:Consciousness; D003371:Cough / Q000145:classification; D020878:Device Removal / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D008297:Male; D008511:Medicine; D008875:Middle Aged; D010818:Practice Patterns, Physicians'; D012494:Sampling Studies; D013038:Specialization; D011795:Surveys and Questionnaires; D014139:Tracheostomy / Q000706:statistics & numerical data*