Clinical indicators associated with successful tracheostomy cuff deflation

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.