Peak inspiratory flow is a simple means of predicting decannulation success following head and neck cancer surgery: a prospective study of fifty-six patients

Abstract

Objectives/hypothesis: Temporary tracheotomies are commonly performed in head and neck cancer surgery. The aim of this study was to propose a minimum peak inspiratory flow (PIF) as a standardized simple tool for successful decannulation after surgery.

Study design: Prospective review between January 2011 and June 2013 in a university teaching hospital.

Methods: Fifty-six patients after head and neck cancer surgery requiring tracheotomies were included. Decannulation failure was defined as the need to recannulate patients within 24 hours. PIF values did not influence the decisions to decannulate or recannulate. Pre- and postdecannulation PIF values, measured with a handheld PIF meter (In-Check Dial), were registered until definitive decannulation.

Results: A total of 67 decannulation attempts were performed, with 47 positive and nine negative decannulations at the first attempt. Of the latter, seven were positive at the second attempt and two at the third. All patients were decannulated (mean, 6.3 days). PIF values of 40 L/min appear to be the threshold with the best sensitivity (90%) and specificity (95%) for predicting decannulation success. There was a significant difference (P < .001) between mean PIF in the positive (86 L/min) and negative (20 L/min) decannulation groups and between mean PIF values with (77 L/min) and without cannula (100 L/min).

Conclusions: PIF ≥40 L/min with cannula (>60 L/min without) using the In-Check Dial oral method is a threshold associated with decannulation success. PIF is a simple quantitative parameter for evaluating the upper airway, aiding the decision to decannulate safely.

Level of evidence: 4.

Keywords: Upper airway; decannulation; head and neck cancer; peak inspiratory flow; tracheotomy.