Resumen
En la unidad de terapia intensiva la traqueostomía se utiliza en pacientes con requerimiento de ventilación mecánica prolongada, o en aquellos con mal manejo de secreciones o con obstrucción de la vía aérea. Una vez superado el proceso que obligó al procedimiento, se debe intentar el retiro de la cánula de traqueostomía. La decanulación de la traqueostomía debe considerarse un proceso que implica la evaluación de competencia de múltiples variables, y si bien no existen consensos ni protocolos que hayan demostrado ser útiles al momento de realizar el proceso, consideramos necesario que el paciente esté liberado de la ventilación mecánica (salvo casos especiales), que tenga permeabilidad de la vía aérea y que logré un correcto manejo de sus secreciones bronquiales. Cada institución debe contar con un protocolo preciso adecuado a su ambiente de trabajo. La decisión final debe llevarse a cabo en consenso de todo el equipo tratante.Citas
<br />1. Frutos-Vivar Fernando, Esteban Andrés, Apezteguía Carlos, Anzueto Antonio, Nightingale Peter, González Marco, Soto Luis, Rodrigo Carlos, Raad Jean, David Cide, Matamis Dimitros, D' Empaire Gabriel. Outcome of mechanically ventilated patients who require a Tracheostomy. Crit Care Med 2005; 33(2).<br />2. De Leyn Paul, Bedert Lieven, Delcroix Mario, Depuydt Pieter, Lauwers Geert, Sokolov Youri, Van Meerhaeghe Alain, Van Schil Paul. Tracheotomy: clinical review and guidelines. European Journal of Cardio-thoracic Surgery 2007; 32: 412-421.<br />3. Engels Paul, Bagshaw Sean, Meier Michael, Brindley Peter. Tracheostomy: from insertion to decannulation. Can J Surg 2009; 52 (5).<br />4. Wright Shawn, Van Dahm Kelly. Long-term care of the tracheostomy patient. Clin Chest Med 2003; 24: 473- 487.<br />5. Rumbak MJ, Graves AE, Scott MP, et al. Tracheostomy tube occlusion protocol predicts significant tracheal obstruction to airflow in patients requiring prolonged mechanical ventilation. Crit Care Med 1997; 25:413-417<br />6. Dhand Rajiv, Johnson Jeremy. Care of the Chronic Tracheostomy. Respiratory Care 2006; 51 (9).<br />7. Ceriana Piero, Carlucci Annalisa, Navalesi Paolo, Rampulla Ciro, Delmastro Monica, Piaggi GianCarlo, De Mattia Elisa, Nava Stefano. Weaning from tracheotomy in long-term mechanically ventilated patients: feasibility of a decisional flowchart and clinical outcome. Intensive Care Med 2003; 29: 845-848.<br />8. Chan Linda, Jones Alice, Chung Raymond, Hung K. Decannulation of a Tracheotomy Tube in Neurosurgical Patients Peak Flow Rate During Induced Cough: A Predictor of Successful. Am J Crit Care 2010; 19:278-284.<br />9. Bach John, Saporito Lou. Criteria for Extubation and Tracheostomy Tube Removal for Patients With Ventilatory Failure. A Different Approach to Weaning. Chest 1996; 110:1566-71.<br />10. Budweiser Stephan, Baur Tobias, Jörres Rudolf, Kollert Florian, Pfeifer Michael, Heinemann Frank. Predictors of Successful Decannulation Using a Tracheostomy Retainer in Patients with Prolonged Weaning and Persisting Respiratory Failure. Respiration 2012; 84:469-476.<br />11. O'Connor Heidi, White Alexander. Tracheostomy Decannulation. Respir Care 2010; 55(8):1076-1081<br />12. Marchese Santino, Corrado Antonio, Scala Raffaele, Corrao Salvatore, Ambrosino Nicolino. Tracheostomy in patients with long-term mechanical ventilation: A survey. Respiratory Medicine 2010; 104: 749-753.<br />13. De Mestral Charles, Iqba Sameena, Fong Nancy, LeBlanc Joanne, Fata Paola, Razek Tarek, Khwaja Kosar. Impact of a specialized multidisciplinary tracheostomy team on traqueostomy care in critically ill patients. Can J Surg 2011; 54 (3) 167-172.<br />14. Tobin Antony, Santamaria John. An intensivist-led tracheostomy review team is associated with shorter decannulation time and length of stay: a prospective cohort study. Critical Care 2008; 12 (2).<br />15. Ross J, White M. Removal of the tracheostomy tube in the aspirating spinal cord-injured<br />Patient. Spinal Cord 2003; 41: 636-642.<br />16. Chadda Karim, Bruno Louis, Lamine Benaïssa, Djillali Annane, Gajdos Philippe, Jean Claud Raphaël, Fredèric Lofaso. Physiological effects of decannulation in tracheostomized patients. Intensive Care Med 2002; 28:1761-1767.<br />17. Stelfox Henry, Hess Dean, Schmidt Ulrich. North American Survey of Respiratory Therapist and Physician Tracheostomy Decannulation Practices. Respiratory Care 2009; 54 (12).<br />18. Stelfox Henry, Crimi Claudia, Berra Lorenzo, Noto Alberto, Schmidt Ulrich, Bigatello Luca, Hess Dean. Determinants of tracheostomy decannulation: an international survey. Critical Care 2008; 12 (1).<br />19. Christopher Kent. Tracheostomy Decannulation. Respir Care 2005; 50 (4): 538 -541.<br />20. St John Robert, Malen Jill. Contemporary issues in adult tracheostomy management. Crit Care Nurs Clin N Am 2004; 16: 413-430.<br />21. Bach John, Goncalves Miguel, Hon Alice, Ishikawa Yuka, De Vito Eduardo, Prado Francisco, Dominguez Maria Eugenia. Changing Trends in the Management of End-Stage Neuromuscular Respiratory Muscle Failure. Recommendations of an International Consensus. Am J Phys Med Rehabil 2012; 91 (11). <br />22. Bach John, Goncalves Miguel. Ventilator weaning by lung expansion and decannulation. Am J Phys Med Rehabil 2004; 83: 560-568<br />23. Heffner John. The technique of weaning from tracheostomy: criteria for weaning; practical measures to prevent failure. J Crit Illn 1995; 10 (10):729-733<br />24. Choate Kim, Barbetti Julie, Currey Judy. Tracheostomy decannulation failure rate following critical illness: A prospective descriptive study. Australian Critical Care 2009; 22: 8-15.<br />25. Veelo Denise, Schultz Marcus, Phoa Kai, Dongelmans Dave, Binnekade Jan, Spronk Peter. Management of Tracheostomy: A Survey of Dutch Intensive Care Units. Respiratory Care 2008; 53 (12).<br />26. Bittner Edward, Schmidt Ulrich. The Ventilator Liberation Process: Update on Technique, Timing, and Termination of Tracheostomy. Respiratory Care 2012; 57 (10).<br />27. Bourjeily Ghada, Habr Fadlallah, Supinski Gerald. Review of Tracheostomy Usage: Complications and Decannulation Procedures. Part II. Clin Pulm Med 2002; 9 (5): 273-278.<br />28. Frank Ulrike, Mader Mark, Sticher Heike. Dysphagic Patients with Tracheotomies: A Multidisciplinary Approach to Treatment and Decannulation Management. Dysphagia 2007; 22:20-29.<br />29. Hernandez G, Ortiz R, Pedrosa A, Cuena R, Vaquero Collado C, Gonzalez Arena P. The indication of tracheostomy conditions the predictors of time to decannulation in critical patients. Medicina Intensiva 2012; 36 (8): 531-539.<br />30. O'Connor Heidi, Kirby Kelly, Terrin Norma, Hill Nicholas, White Alexander. Decannulation Following Tracheostomy for Prolonged Mechanical Ventilation. Journal of Intensive Care Medicine 2009; 24 (3): 187-194.<br />31. Gao Chunli, Zhou Liang, Wei Chunsheng, Hoffman Matthew, Li Cai, Jiang Jack. The evaluation of physiologic decannulation readiness according to upper airway resistance measurement. Otolaryngology-Head and Neck Surgery 2008; 139: 535-540.<br />32. Norwood M, Spiers P, Bailiss J, Sayers R. Evaluation of the role of a specialist tracheostomy service. From critical care to outreach and beyond. Postgrad Med J 2004; 80:478-480.<br />33. MacIntyre Neil, Epstein Scott, Carson Shannon, Scheinhorn David, Christopher Kent, Muldoon Sean; National Association for Medical Direction of Respiratory Care. Management of patients requiring prolonged mechanical ventilation: report of a NAMDRC consensus conference. Chest 2005; 128 (6): 3937-3954. <br />
La revista no retiene los derechos de reproducción (copyright) por lo que los autores pueden volver a publicar sus trabajos con la sola mención a la fuente original de publicación.