Peak Flow Rate During Induced Cough: A Predictor of Successful Decannulation of a Tracheotomy Tube in Neurosurgical Patients

Abstract

Background An accurate predictor of successful decannulation in neurosurgical patients that indicates the best time for tracheotomy decannulation would minimize the risks of continued cannulation and unsuccessful decannulation.Objective To determine whether the peak flow rate during induced cough is an appropriate predictor of successful decannulation.Methods A total of 32 neurosurgical patients with a tracheotomy were enrolled. The highest peak expiratory flow rate during 3 induced coughs, the total volume of tracheal secretions collected in 6 hours, and scores on the Glasgow Coma Scale were recorded. Logistic regression analysis was applied to determine the relationship between these variables and successful decannulation (reintubation not required within 72 hours).Results Decannulation was attempted in 23 of 32 patients. The remaining 9 patients were considered clinically inappropriate for the procedure. Of the 23 patients decannulated, 2 required reinsertion of the tracheotomy tube. Analysis revealed that peak flow rate during induced cough (odds ratio, 1.12; 95% confidence interval, 1.02–1.23) was independently associated with successful decannulation (accuracy, 75%; sensitivity, 85.7%; specificity, 54.5%). The receiver operating characteristic curve indicated an optimal cutoff point of 29 L/min.Conclusion Measurement of peak flow rate during induced cough is a simple and reproducible intervention that improves predictability of successful decannulation in patients with tracheotomy.