Decannulation: a retrospective cohort study of clinical and swallowing indicators of success

• Published in: Clinics (São Paulo, Brazil) Vol. 77; p. 100071
• Main Authors: Escudero, Carina, Sassi, Fernanda Chiarion, de Medeiros, Gisele Chagas, de Lima, Maíra Santilli, Cardoso, Paulo Francisco Guerreiro, de Andrade, Claudia Regina Furquim
• Format: Journal Article
• Language: English
• Published: Elsevier España, S.L.U 01-01-2022; Hospital das Clinicas da Faculdade de Medicina da Universidade de Sao Paulo; Faculdade de Medicina / USP
• Subjects: Decannulation; MEDICINE, GENERAL & INTERNAL; Original; Speech therapy; Swallowing; Swallowing disorders; Tracheostomy; Swallowing disorders; Tracheostomy; Swallowing; Decannulation; Speech therapy
• DOI: 10.1016/j.clinsp.2022.100071
• EISSN: 1980-5322
• ISSN: 1807-5932; 1980-5322

•Deccanulation indicators were investigated in patients who were submitted to a tracheostomy procedure.•Early swallowing evaluation and rehabilitation were associated with a successful decannulation process.•Low swallowing functional levels were negatively associated with the success of decannulation.
To investigate the clinical and swallowing indicators related to a successful decannulation process during the hospital stay.
A retrospective cohort clinical study. The study sample comprised a heterogeneous patient population who had submitted to a tracheostomy procedure in a tertiary hospital. Patients were divided into two groups (decannulated vs. non-decannulated) and compared not only in terms of demographic and clinical data but also the results of a swallowing assessment and intervention outcome.
Sixty-four patients were included in the present study: 25 (39%) who had been successfully decannulated, and 39 (61%) who could not be decannulated. Between-group comparisons indicated that both groups presented similar clinical and demographic characteristics. The groups also presented similar swallowing assessment results prior to intervention. However, significant differences were observed regarding the time to begin swallowing rehabilitation. The decannulated group was assessed nine days earlier than the non-decannulated group. Other significant differences included the removal of the alternate feeding method (72.0% of decannulated patients vs. 5.1% of non-decannulated patients) and the reintroduction of oral feeding (96.0% of decannulated patients vs. 41.0% of non-decannulated patients) and functional swallowing level at patient disclosure. The non-decannulated patient group presented higher death rates at disclosure.
The results of the present study indicated that the following parameters were associated with a successful decannulation process: early swallowing assessment, swallowing rehabilitation, and improvement in the swallowing functional level during the hospital stay. The maintenance of low swallowing functional levels was found to be negatively associated with successful decannulation.