Evidence for the decannulation of people with SCI is lacking. People may not meet the traditional criteria for decannulation and should be assessed on an individual basis (Bach & Alba 1990; Ross & White 2003).
Kim et al. (2017a) retrospectively studied 62 patients with complete or sensory incomplete cervical SCI who received an invasive acute phase respiratory management (including mechanically assisted coughing and NIV). They found that TOT decannulation was possible and noninvasive respiratory intervention, including NIV and mechanically assisted coughing, was an effective long-term alternative to TOT.
Kang et al. (2016) conducted a pre-post design on 16 patients with neuromuscular diseases (5 patients with SCI) who were tracheostomized and did not satisfy the criterion for decannulation. They tested on an objective criterion for decannulation using an external control device substituting for glottic function among patients whose assisted peak cough flow (APCF) without the device was <160L/min. If their APCF with the device was measured as ≥160L/min, they were decannulated. This objective and accurate measurement of APCF was shown to be beneficial in determining TOT decannulation, particularly in patients whose APCF was ≥160L/min while using the device, even if APCF was <160L/min without this device.
Ross and White (2003) described a case series of 4 people with SCI who were successfully decannulated despite the presence of traditional contraindications for decannulation such as evidence of aspiration. These 4 people were carefully selected by a multidisciplinary team who opted for decannulation after assessing the overall risks of decannulation vs. the risks of prolonged TOT. Further studies examining the criteria for decannulation of people with SCI are required.
There is level 4 evidence (from one case series study: Kim et al. 2017a) that an invasive acute phase respiratory management (including mechanically assisted coughing and NIV) for patients with cervical SCI receiving TOT or endotracheal intubation provides successful in TOT decannulation; and noninvasive respiratory intervention, including NIV and mechanically assisted coughing, is an effective long-term alternative to TOT.
There is level 4 evidence (from one pre-post study: Kang et al. 2016) that specific criteria and device (external control device substituting for glottic function) used for decannulation which consists of decannulate patients whose APCF without the device was <160L/min, and their APCF with the device was measured as ≥160L/min, is beneficial for determining TOT decannulation in patients with neuromuscular diseases, including patients with SCI.
There is level 4 evidence (from one case series study: Ross & White 2003) that decannulation can be successful in people with evidence of aspiration.