Predictors of successful tracheostomy tube decannulation in neurosurgical patients

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Predictors of successful tracheostomy tube decannulation in neurosurgical patients

 

Author: Chan, Yuk-ying
Title: Predictors of successful tracheostomy tube decannulation in neurosurgical patients
Degree: M.Sc.
Year: 2007
Subject: Hong Kong Polytechnic University -- Dissertations.
Nervous system -- Surgery -- Patients.
Tracheotomy.
Respiratory insufficiency.
Surgical emergencies.
Department: Dept. of Rehabilitation Sciences
Pages: xi, 91 leaves : col. ill. ; 30 cm.
Language: English
InnoPac Record: http://library.polyu.edu.hk/record=b2174131
URI: http://theses.lib.polyu.edu.hk/handle/200/1846
Abstract: Objective: Determination of the appropriate time for tracheostomy decannulation, balancing the substantial risks associated with delayed decannulation and decannulation failure are complex decisions which lead to a strong rationale for developing accurate predictors of decannulation outcomes in neurosurgical patients. This study was undertaken to prospectively compare parameters associated with successful decannulation outcomes. Design: Cross-sectional study Setting: Neurosurgical unit in an acute hospital Patients: 32 neurosurgical patients with tracheostomy Methods: The best peak cough rate (PCF) from three stimulated cough attempts (cough stimulation induced by insertion of a suction catheter), measured with an in-line electronic peak flow meter; the total volume of tracheal secretions collected for 4 times within 6 hours; and the patient's neurological status determined by Glasgow Coma Scale were recorded. Logistic regression analysis was employed to determine the correlation between these variables and successful decannulation (re-intubation not required within 72 hours after decannulation). Results: Among the 32 patients enrolled hi the study, attempts for decannulation were made for 23 patients, of which 21(65.6%) were successful, 2(6.3%) failed and required re-insertion of tracheostomy tube and the other 9(28.1%) patients were not recommended for decannulation and were transferred intubated to a convalescent hospital for extended care. Logistic regression analysis showed that cough strength measured by stimulated PCF (odds ratio, 1.25; 95% confidence interval, 1.05-1.48, p=0.01), was independently associated with successful decannulation and had the accuracy of 77.4% in predicting successful decannulation with sensitivity of 85% and specificity of 60%. By constructing a receiver operator characteristic (ROC) curve, an optimum cutoff point of 29 L/min (stimulated PCF >= 29 L/min) was obtained. The volume of tracheal secretions and Glasgow Coma Scale (GCS) scores were not associated with decannulation outcomes. Conclusion: This study suggests that stimulated cough strength, measured objectively, is a predictor of decannulation outcomes. This simple, reproducible method may provide a clinically useful approach to guide the tracheostomy decannulation of neurosurgical patients.

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