Tracheostomy Decannulation and Cough Peak Flows in Patients with Neuromuscular Weakness

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Abstract
Objective The aim of this study was to examine the relationship between cough peak flows (CPFs) before and after tracheostomy tube removal (decannulation) in patients with neuromuscular respiratory muscle weakness. Design For 26 patients with occluded tracheostomies (capped or Passy-Muir valve), spontaneous CPF (CPFsp), CPF after lung volume recruitment (CPFLVR), and CPF after lung volume recruitment and a manually assisted cough (CPFLVR + MAC) were measured before and after decannulation. Results Decannulation resulted in a significant increase (P < 0.001) in CPF of 35.6, 34.5, and 42.6 l/min for CPFsp, CPFLVR, and CPFLVR + MAC, respectively. In addition, CPFLVR or CPFLVR + MAC with a capped tracheostomy in place were greater than spontaneous CPF with the tracheostomy tube removed. Conclusions Our study suggests that assisted coughing with a capped tracheostomy tube in place can result in higher flows than removing the tube and relying on spontaneous cough alone. Postdecannulation CPF measured at the mouth can be predicted to be at least 34.5 l/min greater than predecannulation values, which may thereby lower the threshold of the CPF indicated for safe decannulation.