The Science Journal of the American Association for Respiratory Care
Background; This study evaluated the use of a tracheostomy weaning protocol related to the success of decannulization in the acute rehabilitation hospital. The study examined individuals with spinal chord injuries (SCI), traumatic brain injury (TBI), neuromuscular dysfunction (NMD) and ventilator dependent respiratory failure (VDRF). Most individuals had no prior pulmonary history but required mechanical ventilation during the initial stages of their injury. The patient population was between the age of 9 and 84 with a mean age of 49. A multi-skilled inter-disciplinary team approach was established. The team was composed of a physician, nurse practitioner, primary nurse, respiratory care practitioner (RCP), and speech and language therapist (SLT). Method; Patient were admitted to the rehabilitation facility for tracheostomy weaning. Either a cuffed (80 clients) or uncuffed tracheostomy tube (13 clients) were present from the referring hospital. This study was concerned only with the total length of time for decannulization. Data was collected on 93 patients during an 18 month period.
1. Candidates for decannulization were identified and the ?Tracheostomy Weaning Protocol? was ordered by the physician.
2. The RCP and SLT implemented the protocol, steps include:
a. evaluated each patient for high-risk decannulization
b. determine the need for an ENT consult.
c. downsize tracheostomy was downsized to #5 or #6 metal tracheostomy dependent on patient need.
d. once the metal tracheostomy has been downsized to #5, begin plugging trials with observation QID. Extend trials to all day as tolerated
e. tracheostomy collar humidification H.S.,
f. once downsized to #4 metal tracheostomy and plugged, consider decannulization with physician's approval.
g. Decannulate and evaluate decannulization tolerance
h. Perform stoma care and evaluate stoma closure.
3. Protocols are held for signs and symptoms of respiratory distress due to upper airway obstruction, increased secretions and/or aspiration.
Results: Of the 93 tracheostomy patients evaluated, 93.5 % qualified within the tracheostomy weaning protocol parameters. The remaining patients 6.5% were disqualified based on multiple complications such as prolonged inability to protect upper airway and continued ventilator support. 100% of those individuals that qualified for decannulization, were successfully weaned within 50 days. The average decannulization for uncomplicated tracheostomy (less than 21 days) was 10.246 days which represents 74% of the weanable population. Conclusion; Base on our finding, a tracheostomy weaning protocol utilizing the team approach can improve the rehabilitative capacity of the patient. This is accomplished by accelerating the decannulization process, improve communication and therapy participation and reducing nosocimial infection thus decreasing hospitalization cost.