Factors Influencing Decannulation of Tracheostomy in Public Sector Tertiary Care Hospitals

Abstract

Background: Tracheostomy is a surgical procedure that involves making an incision in the neck to create an opening through the trachea. This opening is used independently as an airway or as a site for tracheostomy tube insertion. The tube allows a person to breathe without relying on their nose or mouth. This procedure is performed on patients who require prolonged mechanical ventilation or those with upper airway obstructions. Decannulation is the gradual withdrawal process from a tracheostomy tube. It aims to restore the patient's ability to breathe spontaneously without assistance from the tube. Objective: To determine the factors associated with the decannulation of tracheostomy tube, and to find the effect of tracheostomy tube related complications on the decannulation outcome. METHODOLOGY: An observational cross-sectional study was conducted among patients who had undergone tracheostomy through a modified questionnaire at tertiary care hospitals in Peshawar. A total of 56 patients were sampled from the ICU and HDU, and the data were analyzed by using IBM SPSS Statistics 26.0. RESULTS: 56 patients were assessed for tracheostomy tube decannulation. Among them, 76.8% were male and 23.2% were female. They were admitted to the ICU with various types of diseases. The most common disease among them was pulmonary disease, which affected 19.6% patients, 17.9% patients had a neurological disease, and 62.5% patients had other diseases. Out of these, 11 patients (19.6%) had tetanus. During decannulation, 15 patients (26.8%) developed complications. Out of these patients, 7 (12.5%) developed edema, 2 (3.6%) developed septicemia, 4 patients (7.1%) developed tracheoesophageal fistula, 1 patient (1.8%) had stenosis, and 1 patient (1.8%) had stoma enlargement. Significant majorities of 41 patients (73.2%) were able to successfully decannulate from the procedure, while 15 patients (26.8%) were unable to decannulate and required reintubation. CONCLUSION: Several factors can affect successful tracheostomy decannulation, including duration of capping trial, coughing effectively, level of consciousness, ability to swallow, and duration of tracheostomy. According to our results, pulmonary disease is the leading cause of unsuccessful tracheostomy decannulation, followed by tetanus and RTA. One of the most common complications of a tracheostomy tube is laryngeal edema, the second complication is the formation of a tracheoesophageal fistula, the third is septicemia, and the fourth is stenosis or narrowing of the trachea, resulting in unsuccessful decannulation of the tracheostomy tube, making it difficult for the patient to breathe without assistance.

Keywords: Tracheostomy, outcomes, ICU, decannulation, complication