Enrichi et al reported a clinical protocol for determining if a patient with acquired brain injury can have decannulation of tracheostomy. This can help to expedite the decannulation. The authors are from Istituto di Ricovero e Cura a Carattere Scientifico in Venice, Ospedale Niguarda Ca Granda Milan and the University of Padova in Italy.
Patient selection: acquired brain injury with tracheostomy
Outcome: ability to decannulate the patient
Clinical protocol:
(1) ability to cap the tracheostomy for > = 72 hours
(2) endoscopic assessment of airway with patency >= 50%
(3) negative blue dye test
(4) swallowing instrumental assessment following liquid or food administration, with penetration assessment scale <= 5 (no aspiration events)
where:
• The blue dye test consists of placing 1% Evans blue dye on the back of the patient's tongue. The presence of blue-tinged tracheal aspirates suggests aspiration.
• The penetrating assessment ranges from 1 to 8, with 1 = no dysphagia, 2 to 5 = swallowing difficulties, and 6 to 8 = aspiration event.
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