Evaluation protocol before, during, and after bronchoscopy-guided swallowing test for decannulation: clinical audit proposal

Abstract

Swallowing is a complex act. In some series, it was found that ~20% of patients under invasive mechanical ventilation in intensive care units are subjected to percutaneous tra-cheostomy; however, the presence of tracheostomy causes an increase in the amount of tracheal secretions, changes in the deglutition mechanism, a higher risk of airway infection, bleeding, and hinders vocalization, causing late complications. Decannulation must be performed as soon as possible, since it facilitates phonation and deglutition. This project presents the methods for undertaking a clinical audit to evaluate patients with tracheostomy before, during, and after bronchoscopy-guided swallowing test for decannulation purposes. The main goal is to evaluate the effectiveness of decannulation in patients with percutaneous tracheostomy through physiological and anatomical examination of the airway and the swallowing mechanism using the bronchoscopic method. This method consists of a series of the following evaluations: 1) select patient candidate for swallowing test; 2) prior preparation of the patient for the swallowing test; and 3) transnasal phase, which decides if the patient should be decannulated, consisting of evaluation of the bronchoscopy-guided swallowing test. The patient should not have alterations. If he/she has no alterations in the transnasal and/or transtracheostomy phases, the patient is decannulated. A reliable procedure will be performed by the study data collectors. Data will be analyzed according to the nature of the variables. Decannulation success will be determined by inferential statistics.