title: Clinical indicators associated with successful tracheostomy cuff deflation.
abstract: BACKGROUND
  Tracheostomy cuff deflation is a necessary stage of the decannulation pathway, yet the optimal clinical indicators to guide successful cuff deflation are unknown.
  
  
  OBJECTIVE
  The study aims were to identify (1) the proportion of patients tolerating continuous cuff deflation at first attempt; (2) the clinical observations associated with cuff deflation success or failure, including volume of above cuff secretions and (3) the predictive capacity of these observations within a heterogeneous cohort.
  
  
  METHODS
  A retrospective review of 113 acutely tracheostomised patients with a subglottic suction tube in situ was conducted.
  
  
  RESULTS
  Ninety-five percent of patients (n=107) achieved continuous cuff deflation on the first attempt. The clinical observations recorded as present in the 24h preceding cuff deflation included: (1) medical stability, (2) respiratory stability, (3) fraction of inspired oxygen ≤0.4, (4) tracheal suction ≤1-2 hourly, (5) sputum thin and easy to suction, (6) sputum clear or white, (7) ≥moderate cough strength, (8) above cuff secretions ≤1ml per hour and (9) alertness≥eyes open to voice. Using the presence of all 9 indicators as predictors of successful cuff deflation tolerance, specificity and positive predictive value were 100%, although sensitivity was only 77% and negative predictive value 19%. Refinement to a set of 3 clinically driven criteria (medical and respiratory stability, above cuff secretions ≤1ml/h) provided high specificity (100%), sensitivity (95%), positive predictive value (100%) and an improved negative predictive value (55%).
  
  
  CONCLUSIONS
  Key criteria can help guide clinical decision-making on patient readiness for cuff deflation.
authors.affiliation: Royal Adelaide Hospital, Intensive Care Unit, SA, Australia; The University of Queensland, School of Health & Rehabilitation Sciences, QLD, Australia. Electronic address: lee.pryor@sa.gov.au.
authors.forename: Lee N
authors.initials: LN
authors.lastname: Pryor
authors.affiliation: The University of Queensland, School of Health & Rehabilitation Sciences, QLD, Australia; Centre for Functioning & Health Research (CFAHR), QLD, Australia.
authors.forename: Elizabeth C
authors.initials: EC
authors.lastname: Ward
authors.affiliation: The Prince Charles Hospital, Metro North Hospital and Health Service, QLD, Australia; School of Applied Psychology, Menzies Health Institute Queensland, Griffith University, QLD, Australia.
authors.forename: Petrea L
authors.initials: PL
authors.lastname: Cornwell
authors.affiliation: Royal Adelaide Hospital, Intensive Care Unit, SA, Australia; The University of Adelaide, School of Medicine, SA, Australia.
authors.forename: Stephanie N
authors.initials: SN
authors.lastname: O'Connor
authors.affiliation: Royal Adelaide Hospital, Intensive Care Unit, SA, Australia; The University of Adelaide, School of Medicine, SA, Australia.
authors.forename: Marianne J
authors.initials: MJ
authors.lastname: Chapman
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D060666:Airway Extubation / Q000379:methods*; D003422:Critical Care / Q000379:methods; D003657:Decision Making; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D012189:Retrospective Studies; D014139:Tracheostomy / Q000295:instrumentation*; D016896:Treatment Outcome
keywords: Clinical indicators; Criteria; Cuff deflation; Decannulation; Subglottic suction; Tracheostomy