Decannulation: sociodemographic, clinical and speech-language indicators predictive of success

Côrte, Margaret Mendonça Diniz da; Vicente, Laélia Cristina Caseiro; Friche, Amélia Augusta de Lima

doi:10.1590/2317-6431-2018-2103

Brasil

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Original Article • Audiol., Commun. Res. 24 • 2019 • https://doi.org/10.1590/2317-6431-2018-2103 linkcopy

Decannulation: sociodemographic, clinical and speech-language indicators predictive of success

Authorship SCIMAGO INSTITUTIONS RANKINGS

ABSTRACT

Purpose Identify the prevalence of success in decannulation in adult tracheostomized patients and the sociodemographic, clinical and speech-language indicators predictive in the process.

Methods Retrospective, observational study with analysis of medical records of 189 hospitalized tracheostomized adult patients, from June 2014 to December 2016, comparing the sociodemographic, clinical and speech-language variables between the decannulated and non-decannulated groups through univariate and multivariate logistic analyses.

Results Success in decannulation was 42.8%. The proportion of females and males was similar in both groups, with lower mean age for the decannulated patients. The most frequently observed diseases in both groups were diabetes mellitus and neurological diseases. There was a greater proportion of decannulated patients among those who presented functional swallowing, absence of vocal disorders, spontaneous swallowing of saliva, higher levels of consciousness, oral feeding, negative Blue Dye test results, effective cough, ability to remove lung secretions, absence of abundant secretions, deflated cuff, replacement of plastic cannula with metal cannula, absence of active infections, and absence of oxygen therapy. Multivariate analysis revealed the following variables as associated with success in decannulation: absence of abundant secretions, ability to remove lung secretions, and tracheostomy-tube occlusion time.

Conclusion Decannulation occurred in 42.8% of the hospitalized adult patients and the indicators predictive of success in this process were associated with pulmonary secretion and stomal occlusion capacity, keeping the upper airway open.

Keywords: Tracheostomy; Cannula; Deglutition disorders; Cough; Speech, Language and hearing sciences

Characteristics	Decannulation		p value ^{^} Chi-squared test
Characteristics	Yes n (%)	No n (%)	p value ^{^} Chi-squared test
Gender
Male	45 (55.6)	56 (51.9)	0.613
Female	36 (44.4)	52 (48.1)
Total	81 (100)	108 (100)
Baseline disease and associated comorbidities
Neurological disease	32 (39.5)	36 (33.3)	0.382
Diabetes mellitus	30 (37.0)	45 (41.7)	0.52
Respiratory disease	16 (19.8)	25 (23.1)	0.575
Kidney disease	14 (17.3)	12 (11.1)	0.223
Cancer	8 (9.9)	7 (6.5)	0.393
Psychiatric illness	6 (7.4)	2 (1.9)	0.066
Gastrointestinal disease	6 (7.4)	20 (18.5)	0.028
Dementia	2 (2.5)	2 (1.9)	0.575
Cardiovascular disease	2 (2.5)	3 (2.8)	0.634
Age (years)
Median	68	76	<0.001 ^ Mann Whitney test
Mean	66.9	73.9
Standard deviation	11.8	11
Minimum	36	19

Characteristics	Decannulation		p value ^* * Chi-squared Pearson’s test or Fisher’s exact test;
Characteristics	Yes N (%)	No N (%)
CLINICAL
Level of consciousness
09-12	12 (14.8)	79 (73.1)	<0.001
13-15	69 (85.2)	29 (26.9)
Total	81 (100.0)	108 (100.0)
Active infections
Yes	74 (91.4)	40 (37.0)	<0.001
No	7 (8.6)	68 (63.0)
Total	81 (100.0)	108 (100.0)
Tolerance to cuff deflation
Yes	81 (100)	24 (22.2)	<0.001
No	0 (0.0)	84 (77.8
Total	81 (100.0)	108 (100.0)
Replacement of plastic tube with metal tube
Yes	74 (91.4)	29 (26.9)	<0.001
No	7 (8.6)	79 (73.1)
Total	81 (100.0)	108 (100.0)
Presence of oxygen therapy
Yes	67 (82.7)	4 (13.3)	<0.001
No	14 (17.3)	26 (86.7)
Total	81 (100.0)	30 (100.0)
Tracheostomy-tube occlusion time (TOT)
<24 h	10 (12.3)	105 (97.2)	<0.001
≥24 h	71 (87.7)	3 (2.8)
Total	81 (100.0)	108 (100.0)
SPEECH-LANGUAGE
Spontaneous swallowing of saliva
Yes	80 (98.8)	48 (44.4)	<0.001
No	1 (1.2)	60 (55.6)
Total	81 (100.0)	108 (100.0)
Deglutition at decannulation
Functional swallowing	72 (88.9)	18 (16.7)	<0.001
Dysphagia	9 (11.1)	90 (83.3)
Total	81 (100.0)	108 (100.0)
Oral feeding (VO)
Yes	80 (98.8)	20 (18.5)	<0.001
No	1 (1.2)	88 (81.5)
Total	81 (100.0)	108 (100.0)
Vocal disorders
Absent	47 (58.0)	4 (3.7)	<0.001
Present	34 (42.0)	104 (96.3)
Total	81 (100.0)	108 (100.0)
Blue Dye test (N=141) ^ Blue Dye test not performed with 48 individuals
Negative	73 (96.1)	21 (32.3)	<0.001
Positive	3 (3.9)	44 (67.7)
Total	76 (100.0)	65 (100.0)
Effective cough
Yes	79 (97.5)	46 (42.6)	<0.001
No	2 (2.5)	62 (57.4)
Total	81 (100.0)	108 (100.0)
Ability to remove lung secretions
Yes	78 (96.3)	29 (26.9)	<0.001
No	3 (3.7)	79 (73.1)
Total	81 (100.0)	108 (100.0)
Absence of abundant secretion
Yes	76 (93.8)	20 (18.5)	<0.001
No	5 (6.2)	88 (81.5)
Total	81 (100.0)	108 (100.0)
Use of phonation valve
Yes	50 (61.7)	33 (30.6)	<0.001
No	31 (38.3)	75 (69.4)
Total	81 (100.0)	108 (100.0)

Characteristics	Decannulation		p value ^* * Mann Whitney test
Characteristics	Yes	No	p value ^* * Mann Whitney test
Intubation time (days)
Median	12	11	0.895
Mean	12.05	11.88
Standard deviation	5.36	4.87
Minimum	2	0
Maximum	33	27
Mechanical ventilation time (days)
Median	20	25.5	0.072
Mean	26.07	29.38
Standard deviation	18.5	25.82
Minimum	4	5
Maximum	120	250
Tracheostomy-tube occlusion time (hours)
Median	72	0	<0.001
Mean	60.54	2.6
Standard deviation	32.49	8.82
Minimum	0	0
Maximum	120	72

Characteristics	Success in decannulation in tracheostomized patients
	Initial Model				Final Model
	OR	95%CI	Total sample subjects	p value*	OR	95%CI	Total sample subjects	p value ^* * Wald test
Age	0.96	0.879	1.038	0.28	−	−	−	−
Absence of gastrointestinal disease	5.11	0.413	63.298	0.204	−	−	−	−
Absence of vocal disorders	2.61	0.326	20.813	0.366	−	−	−	−
Presence of effective cough	8.29	0.055	1247.838	0.408	−	−	−	−
Ability to remove lung secretions	5.92	0.55	63.629	0.142	14.22	2.01	100.57	0.008
Absence of abundant secretion	12.6	1.264	125.612	0.031	28.66	4.657	176.38	<0.001
Use of phonation valve	0.61	0.098	3.819	0.599	−	−	−	−
Cannula replacement	3.38	0.343	33.437	0.297	−	−	−	−
Absence of active infections	5.45	0.726	40.928	0.099	−	−	−	−
Mechanical ventilation time (days)	0.96	0.893	1.028	0.232	−	−	−	−
Tracheostomy-tube occlusion time (hours)	1.08	1.037	1.126	<0.001	1.09	1.049	1.125	<0.001
Level of consciousness 9-12	1.25	0.209	7.496	0.807	−	−	−	−

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Academia Brasileira de Audiologia Rua Itapeva, 202, conjunto 61, CEP 01332-000, Tel.: (11) 3253-8711 - São Paulo - SP - Brazil
E-mail: revista@audiologiabrasil.org.br

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[TFN10000] ^*
Chi-squared test

[TFN20000] ^**
Mann Whitney test

[3] Subtitle: N = number of individuals