Clinical Implications of Assisted Peak Cough Flow Measured with External Glottic Control Device for Tracheostomy Decannulation in the Patients with Neuromuscular Diseases and Cervical Spinal Cord Injuries: A Pilot Study

Publication date: Available online 19 March 2016
Source:Archives of Physical Medicine and Rehabilitation
Author(s): Seong-Woong Kang, Won Ah Choi, Yu Hui Won, Jang-Woo Lee, Hoo Young Lee, Dong Jin Kim
ObjectiveTo investigate the clinical usefulness and significance of an external control device substituting glottic function in determining feasibility of decannulation in tracheostomized patients with neuromuscular diseases or cervical spinal cord injuries, whose assisted peak cough flows (APCFs) were unmeasurable or lower than 160L/min.DesignBefore-after trialSettingInpatient setting in a university hospitalParticipantsSixteen tracheostomized subjects, 11 with neuromuscular diseases and 5 with cervical spinal cord injuries were recruited.InterventionsUnassisted and assisted peak cough flows (PCFs) were measured with and without an external glottic control device. Among the patients whose APCFs without the device were lower than 160L/min, if their APCFs with the device were measured as 160L/min or higher, they were decannulated. After decannulation, unassisted and assisted PCFs were measured again.Main Outcome MeasuresAPCF with and without an external glottic control device, and APCF after decannulation.ResultsAfter successful decannulation, the APCFs were equal to or higher than those measured with the device before decannulation. No patients received intubation or re-tracheostomy, and there were no respiratory complications.ConclusionsThe external glottic control device substituting for innate glottic function is beneficial for determining tracheostomy decannulation. It provides an objective and accurate APCF. It is particularly helpful for patients whose APCFs are 160L/min or more while using the device, even if the APCFs are lower than 160L/min without it.



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