Tracheostomy Tube Pressure Measurement as Predictor of Capping Test Success in Patients Undergoing Decannulation

Résumé fourni par la source

Decannulation is the final goal for tracheostomized patients but literature is still based on expert opinion. A common criterion for safe decannulation is the capping test, where the tracheostomy tube is temporarily occluded. The role of tracheostomy tube pressure measurements during capping is underexplored. To evaluate tracheostomy tube pressure measurement as predictor of capping test success in patients eligible for decannulation and to establish an optimal pressure threshold predictive of test failure. This prospective observational study was conducted at the Pulmonary Rehabilitation Unit of ICS Maugeri, Pavia. Patients with tracheostomy and a potential indication for decannulation were enrolled. Exclusion criteria included disease requiring continuous invasive ventilation. Tracheal pressures were measured using a manometer connected to the tracheostomy tube before capping and delta inspiratory-espiratory pressure was calculated. The capping test was deemed successful if tolerated for 48 hours. A total of 35 patients were included, with a mean age of 65.1 ± 14.1 years. The overall decannulation success rate was 97.1%. The only variable significantly associated with capping test failure was delta tracheal pressure (median: 22.0 [13.5–32.5] cmH2O vs. 4.0 [4.0–7.0] cmH2O, p < 0.01). A delta pressure threshold >10 cmH2O predicted capping failure with 87% sensitivity and 100% specificity. Tracheal pressure measurement is a predictor of capping test success in tracheostomized patients. A delta pressure >10 cmH2O strongly correlates with test failure, suggesting its potential role for decannulation.

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