Predictors of Tracheostomy Tube Decannulation Success: Analysis of Global Tracheostomy Collaborative Registry

Monday, September 30, 2024

1:24 PM – 1:30 PM EDT

Location: MBCC, 208

Disclosure(s):

Vinciya Pandian, PhD, MBA, MSN, FCCM, FAANP, FAAN, FFNMRCSI:

faculty for this accredited education activity has no relationship(s) with ineligible companies to disclose.

Charissa J. Zaga, BSpPath, MPH:

faculty for this accredited education activity has no relationship(s) with ineligible companies to disclose.

Michael J. Brenner, MD, FACS:

faculty for this accredited education activity has no relationship(s) with ineligible companies to disclose.

Introduction: Tracheostomy indications are well-established; however, disparities exist in clinical approaches to achieving successful and timely decannulation, with prolonged cannulation correlating with elevated tracheostomy-related adverse events and impeding hospital discharge. The objectives of our study were to examine the characteristics of patients who underwent successful versus unsuccessful decannulation during their primary admission and identify predictors of successful decannulation.

Methods: Secondary analysis of data from the Global Tracheostomy Collaborative Registry, encompassing entries from 2013-2022. Study subjects were those who received a tracheostomy. Independent factors include patient characteristics (comorbid conditions, baseline presentation), pre-tracheostomy insertion factors (airway grade, acuity), and tracheostomy factors (tube type, clinical practices facilitating decannulation). Outcome measures encompass tracheostomy-related adverse events and successful decannulation.

Results: The study included data from 6,063 admissions across 29 hospitals, sourced from 19 hospitals in the United Kingdom, six in Australia, and 4 in the United States of America. Per hospital, the median number of admissions was 79 (IQR=138), ranging from 11 – 1,512. The mean age was 58.2 years (SD 15.2), with nearly two-thirds of patients (63%) being male. Ventilation facilitation was the predominant tracheostomy indication. Approximately half of the patients (n = 2,987, 49.3%) were decannulated by discharge, exhibiting variations by country. The median tracheostomy days were 16 (IQR = 20), and the length of stay was 34 days (IQR = 40). The majority of patients (n = 5,263, 86.8%) survived to discharge.

Conclusions: Geographic variations in clinical practices for facilitating decannulation and discrepancies in discharge options for non-decannulated patients exist. Modifiable clinical variables present opportunities for enhanced pre-tracheostomy education to patients, families, and care teams, promoting timely and successful decannulation.

Presenting Author(s)

Vinciya Pandian, PhD, MBA, MSN

Associate Dean of Graduate Education
The Pennsylvania State University College of Nursing
Forest Hill, Maryland, United States

Disclosure(s):
faculty for this accredited education activity has no relationship(s) with ineligible companies to disclose.

Senior Author(s)

Vinciya Pandian, PhD, MBA, MSN

Associate Dean of Graduate Education
The Pennsylvania State University College of Nursing
Forest Hill, Maryland, United States

Disclosure(s):
faculty for this accredited education activity has no relationship(s) with ineligible companies to disclose.

Co-Author(s)

Charissa J. Zaga, BSpPath, MPH

Senior Speech Pathologist & Acute Stream Leader
Austin Health
Heidelberg, Victoria, Australia

Disclosure(s):
faculty for this accredited education activity has no relationship(s) with ineligible companies to disclose.
CM

Carly Milliren, MPH

Biostatistician IV
Boston Children's Hospital, United States

Disclosure information not submitted.
Michael J. Brenner, MD

Associate Professor
University of Michigan Medical School
Ann Arbor, Michigan, United States

Disclosure(s):
faculty for this accredited education activity has no relationship(s) with ineligible companies to disclose.