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

Escudero, Carina; Sassi, Fernanda Chiarion; Medeiros, Gisele Chagas de; Lima, Maíra Santilli de; Cardoso, Paulo Francisco Guerreiro; Andrade, Claudia Regina Furquim de

doi:10.1016/j.clinsp.2022.100071

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Original articles • Clinics 77 • 2022 • https://doi.org/10.1016/j.clinsp.2022.100071 copy

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

Authorship SCIMAGO INSTITUTIONS RANKINGS

Abstract

Objective:

To investigate the clinical and swallowing indicators related to a successful decannulation process during the hospital stay.

Methods:

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 (dec-annulated 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.

Results:

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.

Conclusion:

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.

HIGHLIGHTS

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.

	Decannulated individuals (n = 25)	Non-decannulated individuals (n = 39)	p-value
Age (years)
median (P25; P75)	43.0 (35.5; 61.0)	52.0 (43.0; 61.0)	0.24
Sex, n (%)
Male	15 (60.0%)	28 (71.8%)	0.69
Female	10 (40.0%)	11 (28.2%)
SAPS-3 score
median (P25; P75)	53.0 (44.0; 61.0)	52.0 (46.0; 65.0)	0.69
Length of hospital stay (days)
median (P25; P75)	75.0 (55.0; 97.5)	65.0 (45.0; 97.0)	0.51
Number of OTIs
median (P25; P75)	1.0 (1.0; 1.0)	1.0 (1.0; 2.0)	0.44
Translaryngeal intubation duration (days)
median (P25; P75)	13.0 (8.5; 14.0)	13.0 (9.0; 18.0)	0.59
Time between placement of TCT and speech therapy assessment (days)
median (P25; P75)	6.0 (3.0; 14.0)	13.0 (4.0; 27.0)	0.27
MV duration time (days)
median (P25; P75)	15.0 (13.0; 25.0)	16.0 (10.0; 22.0)	0.76
Time between MV independence and speech therapy assessment (days)
median (P25; P75)	4.0 (2.0; 7.5)	5.0 (2.0; 23.0)	0.042^a a Significant difference according to the Mann-Whitney U test.** Significant difference according to Pearson’s Chi-Square test.
Time from first SLT assessment to successful decannulation (days)
median (P25; P75)	47.0 (30.5; 61.0)	-	-

	Decannulated individuals (n = 25)	Non-decannulated individuals (n = 39)	p-value
Total number of swallowing rehabilitation sessions until the outcome
median (P25; P75)	13.0 (10.0; 22.5)	8.0 (3.0; 15.0)	0.005^a n, Number of participants; P25, 25th percentile; P75, 75th percentile; NES, Nasoenteral tube; GTT, Percutaneous Endoscopic Gastrostomy Tube; OF, Oral Feeding.
Alternative feeding method in the initial speech therapy assessment, n (%)
Fasting	0 (0.0%)	1 (2.6%)	0.68
NES	23 (92.0%)	34 (87.2%)
GTT	2 (8.0%)	4 (10.3%)
Time of use of alternative feeding method in the initial swallowing assessment (days)
median (P25; P75)	18.0 (11.0; 31.0)	21.0 (11.0; 35.0)	0.62
Alternative feeding method in the outcome, n (%)
GTT	1 (4.0%)	14 (35.9%)	<0.001^b a Significant difference according to the Mann-Whitney U test.
OF	18 (72.0%)	4 (10.3%)
GTT + OF	4 (16.0%)	5 (12.8%)
NES	0 (0.0%)	11 (28.2%)
NES+OF	2 (8.0%)	5 (12.8%)
Number of participants who underwent reintroduction oral feeding during swallowing rehabilitation, n (%)	24 (96.0%)	16 (41.0%)	<0.001^b a Significant difference according to the Mann-Whitney U test.
Number of swallowing rehabilitation sessions until return to oral feeding
Median (P25; P75)	4.0 (2.5; 9.0)	5.0 (2.0; 13.0)	0.81
Number of participants who removed alternative feeding method during swallowing rehabilitation, n (%)	18 (72.0%)	2 (5.1%)	<0.001^b a Significant difference according to the Mann-Whitney U test.
Outcome, n (%)
Swallowing therapy discharge	13 (52.0%)	10 (25.6%)	0.032^b a Significant difference according to the Mann-Whitney U test.
Hospital discharge	9 (36.0%)	11 (28.2%)	0.51
Service suspension	0 (0.0%)	9 (23.1%)	0.010^b a Significant difference according to the Mann-Whitney U test.
Transfer to another hospital	3 (12.0%)	11 (28.2%)	0.12
Death	0 (0.0%)	7 (17.9%)	0.025^b a Significant difference according to the Mann-Whitney U test.

	Decannulated individuals (n = 25)	Non-decannulated individuals (n = 39)	p-value
ASHA NOMS total score – initial assessment
Median (P25; P75)	2.0 (1.5; 3.0)	2.0 (1.0; 2.0)	0.25
ASHA NOMS total score – outcome assessment
Median (P25; P75)	7.0 (4.5; 7.0)	2.0 (1.0; 4.0)	<0.001^a a Significant difference according to the Mann-Whitney U test.

ASHA NOMS level	Initial assessment		Outcome assessment
	Decannulated individuals (n = 25)	Non-decannulated individuals (n = 39)	Decannulated individuals (n = 25)	Non-decannulated individuals (n = 39)
1	6 (24.0%)	12 (30.7%)	0 (0.0%)	10 (25.6%)
2	12 (48.0%)	21 (53.8%)	1 (4.0%)	14 (35.8%)
3	4 (16.0%)	5 (12.8%)	1 (4.0%)	5 (12.8%)
4	1 (4.0%)	1 (2.5%)	4 (16.0%)	5 (12.8%)
5	1 (4.0%)	0 (0.0%)	3 (12.0%)	4 (10.2%)
6	0 (0.0%)	0 (0.0%)	3 (12.0%)	1 (2.5%)
7	1 (4.0%)	0 (0.0%)	13 (52.0%)	0 (0.0%)

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[1] * Corresponding author. E-mail address: clauan@usp.br (C.R.F. de Andrade).