Tracheostomy decannulation and cough peak flows in patients with neuromuscular weakness

American Journal of Physical Medicine & Rehabilitation
Douglas A McKimAndrew Woolnough

Abstract

The aim of this study was to examine the relationship between cough peak flows (CPFs) before and after tracheostomy tube removal (decannulation) in patients with neuromuscular respiratory muscle weakness. For 26 patients with occluded tracheostomies (capped or Passy-Muir valve), spontaneous CPF (CPF(sp)), CPF after lung volume recruitment (CPF(LVR)), and CPF after lung volume recruitment and a manually assisted cough (CPF(LVR) + MAC) were measured before and after decannulation. Decannulation resulted in a significant increase (P < 0.001) in CPF of 35.6, 34.5, and 42.6 l/min for CPF(sp), CPF(LVR), and CPF(LVR) + MAC, respectively. In addition, CPF(LVR) or CPF(LVR) + MAC with a capped tracheostomy in place were greater than spontaneous CPF with the tracheostomy tube removed. Our study suggests that assisted coughing with a capped tracheostomy tube in place can result in higher flows than removing the tube and relying on spontaneous cough alone. Postdecannulation CPF measured at the mouth can be predicted to be at least 34.5 l/min greater than predecannulation values, which may thereby lower the threshold of the CPF indicated for safe decannulation.

References

Jul 14, 2000·Chest·S W Kang, J R Bach
Jan 14, 2004·Chest·Milo EngorenNancy Fenn-Buderer
Jun 24, 2004·American Journal of Physical Medicine & Rehabilitation·John Robert Bach, Miguel Goncalves
Nov 13, 2004·Chest·John Robert BachElaine Aufiero

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Citations

Jun 10, 2017·Amyotrophic Lateral Sclerosis & Frontotemporal Degeneration·Jesús SanchoJulio Marín
Feb 7, 2018·Annals of Intensive Care·Nicolas TerziDavid Orlikowski
May 1, 2020·Clinical Otolaryngology : Official Journal of ENT-UK ; Official Journal of Netherlands Society for Oto-Rhino-Laryngology & Cervico-Facial Surgery·Jose Antonio Sanchez-GuerreroSophie Périé

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