Clinical indicators associated with successful tracheostomy cuff deflation

Lee N. Pryor, Elizabeth C. Ward, Petrea L. Cornwell, Stephanie N. O'Connor, Marianne J. Chapman

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9 Citations (Scopus)

Abstract

Background Tracheostomy cuff deflation is a necessary stage of the decannulation pathway, yet the optimal clinical indicators to guide successful cuff deflation are unknown. Objectives The study aims were to identify (1) the proportion of patients tolerating continuous cuff deflation at first attempt; (2) the clinical observations associated with cuff deflation success or failure, including volume of above cuff secretions and (3) the predictive capacity of these observations within a heterogeneous cohort. Methods A retrospective review of 113 acutely tracheostomised patients with a subglottic suction tube in situ was conducted. Results Ninety-five percent of patients (n = 107) achieved continuous cuff deflation on the first attempt. The clinical observations recorded as present in the 24 h preceding cuff deflation included: (1) medical stability, (2) respiratory stability, (3) fraction of inspired oxygen ≤0.4, (4) tracheal suction ≤1–2 hourly, (5) sputum thin and easy to suction, (6) sputum clear or white, (7) ≥moderate cough strength, (8) above cuff secretions ≤1 ml per hour and (9) alertness ≥ eyes open to voice. Using the presence of all 9 indicators as predictors of successful cuff deflation tolerance, specificity and positive predictive value were 100%, although sensitivity was only 77% and negative predictive value 19%. Refinement to a set of 3 clinically driven criteria (medical and respiratory stability, above cuff secretions ≤1 ml/h) provided high specificity (100%), sensitivity (95%), positive predictive value (100%) and an improved negative predictive value (55%). Conclusions Key criteria can help guide clinical decision-making on patient readiness for cuff deflation.

Original languageEnglish
Pages (from-to)132-137
Number of pages6
JournalAustralian Critical Care
Volume29
Issue number3
DOIs
Publication statusPublished - Aug 2016
Externally publishedYes

Keywords

  • Clinical indicators
  • Criteria
  • Cuff deflation
  • Decannulation
  • Subglottic suction
  • Tracheostomy

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