Decannulation Failure

Decannulation failure is defined as the need to replace the airway after the tube has been decannulated.  

This Australian study examined 981 ICU patients who received tracheostomies.  Seventy-seven percent of them were placed percutaneously and 23% were placed surgically.  The mean duration of placement was 16 days.  A total of 823 decisions to decannulate were made, and of these, there were 40 episodes of decannulation failure occurring in 35 patients.  Twenty-four episodes of decannulation failure (60%) occurred within 24 hours of tube removal, with 14 of these cases (58%) occurring within the first 4 hours.  Only two patients failed decannulation beyond 7 days, with one at 8 days and one at 10 days.

The reasons why patients failed decannulation included inability to expectorate secretions (52.8%) stridor, anatomical problems, and new sepsis.  Most stridor emerged within 4 hours of tube removal.  For the patients that failed decannulation multiple times, sputum retention was the primary reason.

In this study, there was no mortality associated with decannulation failure.  Most cases (62.5%) required simple recannulation of the stoma.  Translaryngeal intubation was required in 37.5% of cases.  The median duration between decannulation and reinsertion of a new artificial airway was 18 hours.

Source: Choate, K, Barbetti, J, Currey, J (2009). Tracheostomy decannulation failure rate following critical illness: A prospective descriptive study. Australian Crit Care, 22: 8-15.