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Failure of standard tracheostomy decannulation criteria to detect suprastomal pathology

Failure of standard tracheostomy decannulation criteria to detect suprastomal pathology Meeting established criteria for tracheostomy decannulation should improve success, although there will be a small proportion of patients with a tracheostomy who fail decannulation. Failure rates depend on patient characteristics and disparity between institutional practices and expert opinion. However, there are no widely accepted published failure rates, or agreement on the time‐point at which failure is assessed. We present a patient who had evidence of readiness for decannulation, but had immediate failure due to extrinsic tracheal compression, which proved difficult to diagnose and required surgery to resolve. Capping the tracheostomy before decannulation may or may not have given rise to suspicion of potential failure and this practice requires further evaluation as it is not without risk. For subglottic, but suprastomal lesions, nasendoscopy is not of value. It is important to decannulate patients in a safe environment, preferably early in the day to allow post decannulation observations and interventions should they become necessary, and with the close involvement of the multi‐professional team. This report illustrates the failure of our standard Tracheostomy decannulation criteria, and direct upper airway view to identify suprastomal tracheal pathology, and we discuss the potential for additional criteria which may have identified the issue before decannulation attempts. http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Anaesthesia Reports Wiley

Failure of standard tracheostomy decannulation criteria to detect suprastomal pathology

Thomas, A. J.; Talbot, E.; Drewery, H.
Anaesthesia Reports , Volume 8 (1) – Jan 1, 2020
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References (12)

Publisher
Wiley
Copyright
2020 © Association of Anaesthetists
eISSN
2637-3726
DOI
10.1002/anr3.12048
Publisher site
See Article on Publisher Site

Abstract

Meeting established criteria for tracheostomy decannulation should improve success, although there will be a small proportion of patients with a tracheostomy who fail decannulation. Failure rates depend on patient characteristics and disparity between institutional practices and expert opinion. However, there are no widely accepted published failure rates, or agreement on the time‐point at which failure is assessed. We present a patient who had evidence of readiness for decannulation, but had immediate failure due to extrinsic tracheal compression, which proved difficult to diagnose and required surgery to resolve. Capping the tracheostomy before decannulation may or may not have given rise to suspicion of potential failure and this practice requires further evaluation as it is not without risk. For subglottic, but suprastomal lesions, nasendoscopy is not of value. It is important to decannulate patients in a safe environment, preferably early in the day to allow post decannulation observations and interventions should they become necessary, and with the close involvement of the multi‐professional team. This report illustrates the failure of our standard Tracheostomy decannulation criteria, and direct upper airway view to identify suprastomal tracheal pathology, and we discuss the potential for additional criteria which may have identified the issue before decannulation attempts.

Journal

Anaesthesia Reports – Wiley

Published: Jan 1, 2020

Keywords: decannulation; tracheostomy

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