Tracheostomy decannulation marathons and finish lines 英文参考文献.docVIP

Available online /content/12/2/128 Commentary Tracheostomy decannulation: marathons and finish lines John E Heffner1,2 1Providence Portland Medical Center, NE Hoyt St, Portland, Oregon, 97213 USA 2Oregon Health Science University, SW Sam Jackson Park Rd, Portland, Oregon 97239, USA Corresponding author: John E Heffner, John_heffner@ Published: 31 March 2008 Critical Care 2008, 12:128 (doi:10.1186/cc6833) This article is online at /content/12/2/128 ? 2008 BioMed Central Ltd See related research by Stelfox et al., /content/12/2/R26 Abstract level of consciousness, cough effectiveness, amount of secretions, and oxygenation. Also, respondents defined ‘decannulation failure’ as the need to reintubate the airway within 48 to 96 hours after planned removal of a tracheo- stomy tube. As proposed by the investigators, these obser- vations add to the findings of previous studies [2] and will help in the design of future studies to identify decision support tools for selecting patients for decannulation. Critically ill patients with a tracheostomy who are recovering from airway respiratory failure eventually require evaluation for decannulation. Although expert recommendations guide decisions for managing decannulation, few if any investigative data exist to inform evidence-based care. Consequently, practice variation limits the effectiveness of weaning from tracheostomy. In an investigation reported in this issue of Critical Care, the authors surveyed experienced physicians and respiratory therapists to assess their opinions on managing airway decannulation and identified several clinical factors that they recommend for selecting patients for tracheostomy tube removal. The authors propose that these factors can assist with designing clinical trials of tracheostomy decannu- lation. Pending completion of such studies, this report underscores the problem of practic