Cough Flow as a Criterion Decannulation Threshold in Prolonged Tracheostomy Patients

Официальное название

Multicenter Prospective Validation of Cough Flow With Tracheostomy Tube and Speaking Valve (CFsv) >100 L/Min as a Criterion Decannulation Threshold in Prolonged Tracheostomy Patients

Обзор

Background: International studies have proposed a cough peak flow (CPF) of ≥160 L/min as a reference threshold for safe decannulation. However, this measurement requires prior removal of the tracheostomy tube, which is often difficult for Chinese patients and their families to accept due to cultural and safety concerns. Additionally, there is a lack of rapid, user-friendly, and widely applicable quantitative tools in clinical practice within ICUs or rehabilitation specialties in China. Moreover, the heterogeneity among domestic patient populations with different underlying conditions (such as neuromuscular diseases, spinal cord injuries, stroke, and respiratory failure) makes it challenging to apply a single foreign-derived indicator. In our center's prospective study from 2019 to 2022(Respiratory Research 2024;25:128), the investigators proposed and preliminarily validated that a cough flow measured with tracheostomy tube and speaking valve (CFSV) \>100 L/min could serve as a threshold for safe decannulation. Among 193 patients with long-term tracheostomy tubes, 105 were decannulated based on this threshold, with a success rate of 98.1%. Only two cases required reintubation within 48 hours (1.9%), and the six-month reintubation rate was 2.9%, which is significantly better than previously reported domestic and international data (reintubation rates of 5-15%). For patients with insufficient CFSV, after an average of 26 days of individualized cough enhancement rehabilitation, 91% achieved the threshold and ultimately succeeded in decannulation. This suggests that 100 L/min may be a more physiologically appropriate threshold for Chinese (and even East Asian) populations with indwelling tracheostomy tubes, and that CFSV combined with systematic rehabilitation interventions can significantly improve decannulation rates. However, these conclusions are derived from single-center data with a limited sample size, and the diversity of diseases and regional variations in medical standards may affect generalizability. Therefore, there is an urgent need for multicenter, large-sample prospective studies to validate the effectiveness, accuracy, and feasibility of CFSV \>100 L/min as a quantitative standard for safe decannulation.

Вмешательства

• Другое standardized tracheostomy decannulation protocol
  Step 1: Confirm that the patient is clinically stable. Step 2: Speaking valve (SV) with transtracheal end-expiratory pressure (TTPEE) measurement. Step 3: Measure the CFsv. Step 4: Continue wearing the SV for 4 hours. During this period, suctioning is not performed via the tracheostomy tube. Step 5: Assess readiness for decannulation. The CFsv is measured again prior to decannulation. If the value exceeds 100 L/min, decannulation is performed.

Первичные конечные точки

• Decannulation Success [Срок оценки: 48 hours post-decannulation]

Критерии участия

Критерии включения

• Age ≥18 years
• Tracheostomy tube in place for ≥14 days
• Weaned from ventilator for more than 48 hours, or in a state of spontaneous breathing
• Patient and family members have provided informed consent

Критерии исключения

• Severe craniofacial deformity preventing CFsv measurement
• Known obstructive upper airway pathology precluding tracheostomy tube removal
• Laryngopharyngeal trauma
• Inability to tolerate cuff deflation

Критерии приведены из реестра в оригинале (на английском). Окончательную оценку соответствия проводит исследовательский центр.

Здоровые добровольцы: Нет

Дизайн исследования

Распределение

Не применимо

Модель

Одна группа

Маскирование

Открытое

Основная цель

Диагностика

Центры проведения

Китай · 5 центров

• Beijing Rehabilitation Hospital, Capital Medical University, Beijing,China — Пекин
• Hunan Rehabilitation Hospital — Hunan
• Jiangbin Hospital of Guangxi Zhuang Autonomous Region — Guangxi
• YanBian University Hospital — Jilin City
• Zhengzhou Central Hospital Affiliated to Zhengzhou University — Henan

Идентификаторы

NCT: NCT07317791 · 2025-hxkfzx-dzx-002

Первоисточники (государственные реестры)

• ClinicalTrials.gov (NIH, США)

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