Determination of Decannulation Problems in Tracheostomized Quadriplegic Patients

Tracheostomy decannulation is always difficult in cases of traumatic quadriplegia due to respiratory muscle paralysis, chest infections, aspiration, and the need to care for sacral sores. It is essential to identify and overcome the difficulties in decannulation of tracheostomy in cases of quadriplegia due to cervical spinal cord injury.

A prospective observational study was conducted in a tertiary care Spinal Cord Injury. Centre of a Military Hospital. Over a three-year period, ten tracheostomized traumatic quadriplegics were evaluated. Once the indication for tracheostomy was over, the decannulation was only considered when there was normal gag reflex, effective cough, manageable aspiration, oxygen saturation above 90%, no serious pulmonary compromise and no need for bed sores surgery. The cases were followed for another year after decannulation. Only two cases could not be decannulated due to poor chest movement, ineffective coughing, a lack of motivation, and occasional aspiration.

Patients with cervical cord injuries have difficulty decannulating because of weak respiratory muscles, ineffective coughing, aspiration, pulmonary pathology, and bed sores. Successful decannulation requires respiratory muscle exercise, quantified peak cough pressure, assisted coughing, a risk benefit strategy in aspiration, bed sore healing, and teamwork.