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Title: Removal of the tracheostomy tube in the aspirating spinal cord-injured patient.
Austin Authors: Ross, Jacqueline M ;White, M
Affiliation: Physiotherapy Department, Austin Hospital, Melbourne, Australia
Issue Date: 1-Nov-2003
Publication information: Spinal Cord; 41(11): 636-42
Abstract: Four related case reports, occurring within a 10-month time frame during 2001.Aspiration is commonly reported in the literature as a contraindication to decannulation. We report four examples of successful removal of the tracheostomy tube in the presence of aspiration by an experienced team, utilising a risk management approach.Victorian Spinal Cord Service (VSCS), Austin Hospital, Melbourne, Australia.Four individuals in our unit with traumatic spinal cord injury, three quadriplegic and one paraplegic, presented with aspiration identified by a positive modified Evan's blue dye test or constant coughing, gagging and oxygen desaturation during cuff deflation trials. In three of the four cases, the tracheostomy tube had been in situ for a prolonged period and the patients had failed to progress towards decannulation. A decision was made to decannulate these four patients in spite of the presence of traditionally held contraindications for decannulation. The multidisciplinary team carefully compared the inherent risks of premature decannulation against those of prolonged tracheostomisation. Given the risk associated with this procedure, a closely monitored decannulation protocol was instituted.All four patients were successfully decannulated with improved quality of life, eating between 1 and 4 days and communicating immediately after decannulation. None experienced respiratory deterioration.It is possible to safely decannulate aspirating spinal cord injured individuals in some instances, using a risk management approach.
Gov't Doc #: 14569265
DOI: 10.1038/
ORCID: 0000-0002-2562-1829
Journal: Spinal Cord
Type: Journal Article
Subjects: Adult
Evans Blue.pharmacokinetics
Intermittent Positive-Pressure Ventilation.instrumentation.methods
Intraoperative Complications.therapy
Intubation, Intratracheal.adverse effects.methods
Middle Aged
Monitoring, Physiologic.methods
Respiratory Tract Diseases.etiology
Retrospective Studies
Spinal Cord
Tracheostomy.adverse effects.methods
Appears in Collections:Journal articles

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