Abstract
The purpose of this study was to compare success with the conventional method of capping, or 'plugging, the tracheostomy tube to success with that of using a one-way-airflow valve, in the decannulation of patients with long-term tracheostomies. MATERIALS & METHODS: To be eligible for the study, the patient had to have had a tracheostomy for at least 30 days and be deemed by his primary care physician to be a candidate for decannulation. Patients who were on mechanical ventilation and patients with sleep apnea syndrome, severe aspiration, or clinically apparent upper-airway obstruction were excluded from the study. Twelve patients who were deemed ready for the decannulation protocol were randomly assigned either to cap or one-way valve. The times of occlusion were increased by 1-hour increments/day up to 6 hours and then by 2-hour increments/day up to 24 hours. RESULTS: Ten patients were successfully decannulated; 5 in each group. The median time for decannulation was 18 days with the one-way valve and 23 days with standard capping. We noted no significant difference in the proportion successfully decannulated or time to decannulation between the two groups (p > 0.05). However, patients with the one-way valve appeared to be more comfortable. Pulmonary function testing results varied among and within patients because the patients were unable to cooperate or had uncuffed tubes in place. CONCLUSIONS: In this small group of patients, neither method appeared to be superior, although subjective observation suggested that patients appeared to be more comfortable with the one-way valve. Pulmonary function testing was not useful in predicting successful decannulation.
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