Influence of peripheral muscle strength on the decannulation success rate - Critical Care Science (CCS)

INTRODUCTION: Tracheostomy is probably the most common surgical procedure in critically ill patients and is generally performed to facilitate mechanical ventilation weaning. Evidence-based guidelines have confirmed the benefits of tracheostomy weaning protocols and of the physiotherapists engagement in this process; however, no consensus decannulation criteria are currently available. Therefore, this study aimed to evaluate the influence of peripheral muscle strength and other indicators on decannulation success. METHODS: This was an observational retrospective study that analyzed the medical records of patients admitted to the medical and surgical intensive care unit of Hospital Agamenon Magalhães between March 2007 and August 2009. Respiratory and peripheral muscle strengths were evaluated in decannulated patients. RESULTS: Overall, 1,541 patients were evaluated, 143 of which had been tracheostomized, and only 57 of which had been decannulated. Forty-six patients had a satisfactory decannulation outcome, while 11 had decannulation failure, requiring the return to an artificial airway within 2 weeks. The calculated Medical Research Council peripheral muscle strength score was significantly lower for the failure group than for the successful decannulation group (28.33 ± 15.31 vs. 41.11 ± 11.52; P = 0.04). Scores above or equal 26 had 94.4% sensitivity and 50.0% specificity for the decannulation outcome, with an area under the ROC curve of 0.7593. In addition, white blood cell counts were higher in decannulation failure group patients (14,070 ± 3,073 vs. 10,520 ± 3,402 cells/μL; P = 0.00). CONCLUSION: This study has shown that peripheral muscle strength and blood leucocyte counts evaluated on the day of decannulation may influence the tracheostomy decannulation success rate.