Successful decannulation in patients with COVID-19
DOI:
https://doi.org/10.28957/rcmfr.344Keywords:
Tracheostomy, rehabilitation, mechanical ventilation, Airway obstruction, COVID-19Abstract
Introduction. Patients with COVID-19 are at risk of presenting acute respiratory distress syndrome, therefore, they may require mechanical ventilation and tracheostomy. Thus, decannulation is an important process which is the responsibility of the rehabilitation team.
Objectives. To describe and characterize the decannulation process in tracheostomized patients with COVID-19 in order to identify possible factors that influence its successful performance.
Methods. Cross-sectional descriptive study conducted on the patients who underwent tracheostomy between June 2020 and July 2021 in the Clínica de Alta Complejidad Santa Bárbara in Palmira, Colombia. The categorical variables were presented as percentages, and for quantitative variables, the normality hypothesis was contrasted using the Kolmogorov-Smirnov test.
Results. At the time of admission, the patients had characteristics of severity, with an average PaO2/FiO2 of 99.7 mmHg and neuromuscular blockade for up to 20 days; the average time of mechanical ventilation was 17.3 days. The rehabilitation team performed an intervention on all patients; of the 15 patients included, three were not decannulated. A descriptive analysis of the objectives and the intervention performed by each discipline was carried out; for the three non-decannulated patients, the main barriers and predictors of decannulation failure were analyzed.
Conclusion. Thanks to the establishment of a constant and active multidisciplinary rehabilitation plan in which the patients received intervention from their admission to their discharge, it was possible to successfully decannulate 80% of the tracheostomized patients.
Author Biography
John James Castillo, Magíster en Administración en Salud. Clínica de Alta Complejidad Santa Barbara, Palmira. Colombia.
Fisioterapeuta. Mg Administración en Salud, Clínica de alta complejidad Santa Barbara, Palmira. Colombia
References
Scurr y WC, McGinn J. Operative tracheotomy. Operative Techniques in Otolar yngology. 2007;18(2):85-9. Disponible en: https://doi.org/10.1016/j.otot.2007.05.003
Raimondi N, Vial MR, Calleja J, Quintero A, Cortés-Alban A, Celis E, et al. Guías basadas en la evidencia para el uso de traqueostomía en el paciente crítico. Med Intensiva. 2017;41(2):94-115. Disponible en: https://doi.org/10.1016/j.medin.2016.12.001
De Leyn P, Berdert L, Delcroix M, Depuydt P, Lauwers G, Sokolov Y, et al. Tracheotomy: clinical review and guideline. Eur J Cardiothorac Surg. 2007;32(3):412-21. Disponible en: https://doi.org/10.1016/j.ejcts.2007.05.018
Aguilar-Garduño CO, Aguilar-Garduño JC, Barreto-Rodríguez AK, Ortiz-Higareda V, Ferat-Osorio E, Martínez-Ordaz JL. Surgical initial experience in patients with COVID-19. Cir Cir. 2021;89(2):183-8. Disponible en: https://doi.org/10.24875/CIRU.20000972
Bardell T, Drover JW. Recent developments in percutaneous tracheostomy: improving techniques and expanding roles. Curr Opin Crit Care 2005;11(4):326-32. Disponible en: https://doi.org/10.1097/01.ccx.0000170680.09759.f2
McGrath BA, Ashby N, Birchall M, Dean P, Doherty C, Ferguson K, et al. Multidisciplinary guidance for safe tracheostomy care during the COVID-19 pandemic: the NHS National Patient Safety Improvement Programme (NatPatSIP). Anaesthesia. 2020;75(12):1659-70. Disponible en: https://doi.org/10.1111/anae.15120
Christopher KL. Tracheostomy decannulation. Respir Care. 2005;50(4):538-41.
Maruvala S, Chandrashekhar R, Rajput R. Tracheostomy Decannulation: When and how? Research in Otolaryngology. 2015;4(1):1-6 Disponible en: https://doi.org/10.5923/j.otolaryn.20150401.01
Diaz-Ballve LP, Villalba DS, Andreu MF, Escobar MA, Morel-Vulliez G, Lebus JM, et al. Respiratory muscle strength and state of consciousness values measured prior to the decannulation in different levels of complexity. A longitudinal prospective case series study. Med Intensiva (Engl Ed). 2019;43(5):270-80. Disponible en: https://doi.org/10.1016/j.medin.2018.02.017
Charlson ME, Charlson RE, Peterson JC, Marinopoulos SS, Briggs WM, Hollenberg JP. The Charlson comorbidity index is adapted to predict costs of chronic disease in primary care patients. J Clin Epidemiol. 2008;61(12):1234-40. Disponible en: https://doi.org/10.1016/j.jclinepi.2008.01.006
Carretero-Rodríguez I, Pardal-Refoyo JL. Investigación bibliográfica sobre la decanulación en pacientes traqueotomizados. Revista ORL. 2015 [citado julio 10 de 2016];6(37):160-70. Disponible en: https://dialnet.unirioja.es/servlet/articulo?codigo=5734701
Park C, Ko RE, Jung J, Na SJ, Jeon K. Predicción de decanulación exitosa de pacientes traqueostomizados en unidades médicas de cuidados intensivos. Respir Res. 2021;22(1):131. Diponible en: https://doi.org/10.1186/s12931-021-01732-w
Martínez-Téllez E, Orús-Dotú C, Trujillo-Reyes JC, Guarino M, Cladellas-Gutiérrez E, Planas-Cánovas G, et al. Traqueotomía en pacientes COVID-19: un procedimiento nece- sario de alto riesgo. Experiencia en dos centros. Arch. 2020;56(10):673-4. Disponible en: https://doi.org/10.1016/j.arbres.2020.05.018
Kutsukutsa J, Kuupiel D, Monori-Kiss A, Del Rey -Puech P, Mashamba-Thompson TP. Tracheostomy decannulation methods and procedures for assessing readiness for decannulation in adults: a systematic scoping review. Int J Evid Based Healthc. 2019;17(2):74-91. Disponible en: https://doi.org/10.1097/XEB.0000000000000166
Lugo-Machado JA, Jiménez-Rodríguez M. Proceso de decanulación electiva en pacientes con traqueotomía: búsqueda de criterio. Acta Otorrinolaringol Cir Cabeza Cuello. 2022;49(4):310-14. Disponible en: https://doi.org/10.37076/acorl.v49i4.502
Diaz-Ballve P, Villalba D, Andreu M, Escobar M, Morel-Vulliez G, Lebus J, et al. Decanular. Factores predictores de dificultad para la decanulación. Estudio de cohorte multicéntrico. Revi. Am. med. Respir. 2017;17(1):12-24.
Kwak PE, Connors JR, Benedict PA, Timen MR, Wang B, Zhang Y, et al. Early Outcomes From Early Tracheostomy for Patients With COVID-19. JAMA Otolar yngol Head Neck Surg. 2021;147(3):239-44. Disponible en: https://doi.org/10.1001/jamaoto.2020.4837
Mata-Castro N, Sanz-López L, Pinacho-Martínez P, Varillas-Delgado D, Miró-Murillo M, Mar- tín-Delgado MC. Tracheostomy in patients with SARS-CoV-2 reduces time on mechanical ventilation but not intensive care unit stay. Am J Otolaryngol. 2021;42(2):102867. Disponible en: https://doi.org/10.1016/j.amjoto.2020.102867
Rovir a A , Dawson D, Walker A , Tornari C, Dinham A , Foden N, et al. Tracheostomy care and decannulation during the COVID-19 pandemic. A multidisciplinar y clinical practice guideline. Eur Arch Otorrinolaringol. 2021 ; 278(2):313-21. Disponible en: https://doi.org/10.1007/s00405-020-06126-0
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