Research

Determinants of tracheostomy decannulation: an international survey

Henry Thomas Stelfox¹ , Claudia Crimi² , Lorenzo Berra² , Alberto Noto³ , Ulrich Schmidt² , Luca M Bigatello² and Dean Hess²

¹Department of Critical Care Medicine, University of Calgary, Foothills Medical Centre, EG23A, 1403-29 Street NW, Calgary, AB, Canada, T2N 2T9

²Department of Anesthesia and Critical Care, Massachusetts General Hospital, 55 Fruit Street, Clinics 309, Boston, MA 02114, USA

³Department of Anesthesia and Critical Care, Policlinico Universitario 'G. Martino', University of Messina, Messina, Italy

author email corresponding author email

Critical Care 2008, 12:R26doi:10.1186/cc6802

Published:	26 February 2008

See related commentary by Heffner, http://ccforum.com/content/12/2/128

Abstract

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).

Conclusion

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.