title: Importance of flexible bronchoscopy in decannulation of tracheostomy patients.
abstract: OBJECTIVE
  To evaluate the importance of flexible bronchoscopy in tracheostomy patients in the process of decannulation to assess the incidence and types of laryngotracheal injury and compare the presence of such lesions with clinical criteria used for decannulation.
  
  
  METHODS
  We studied 51 tracheostomized patients aged between 19 and 87 years, with tracheal stent for a mean of 46 ± 28 days and with clinical criteria for decannulation. They were submitted to tracheostomy tube occlusion tolerance testfor 24 hours, and then to flexible bronchoscopy. We described and classified the diagnosed laryngotracheal changes. We compared the clinical criteria for decannulation indication with the bronchoscopy-diagnosed laryngotracheal injuries that contraindicated decannulation. We identified the factors that could interfere in decannulation and evaluated the importance of bronchoscopy as part of the process.
  
  
  RESULTS
  Forty (80.4%) patients had laryngotracheal alterations. Of the 40 patients considered clinically fit to decannulation, eight (20%) (p = 0.0007) presented with laryngotracheal injuries at bronchoscopy that contraindicated the procedure. The most frequent laryngeal alteration was vocal cords lesion, in 15 (29%) individuals, and granuloma, the most prevalent tracheal lesion, in 14 (27.5%) patients.
  
  
  CONCLUSIONS
  flexible bronchoscopy showed a large number of laryngotracheal injuries, the most frequent being the vocal cords injury in the larynx and the granuloma in the trachea, which contributed to increase the decannulation procedure safety.
authors.affiliation: Faculty of Medicine, Universidade Federal de Minas Gerais, Belo Horizonte, Brasil.
authors.forename: Leonardo Brand
authors.initials: LB
authors.lastname: Rodrigues
authors.affiliation: Faculty of Medicine, Universidade Federal de Minas Gerais, Belo Horizonte, Brasil.
authors.forename: Tarcizo Afonso
authors.initials: TA
authors.lastname: Nunes
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001999:Bronchoscopy; D020878:Device Removal; D006801:Humans; D007442:Intubation, Intratracheal; D007830:Larynx / Q000293:injuries*; D008875:Middle Aged; D011446:Prospective Studies; D014132:Trachea / Q000293:injuries*; D014139:Tracheostomy; D014947:Wounds and Injuries / Q000000981:diagnostic imaging; D055815:Young Adult