Research progress of extubation management in patients with tracheotomy_West China Medical Journal

Authors：

LI Simin ^1,2 , WU Xuyi ^1,2 , WANG Jiao ^1,2 , ZENG Jingru ^1,2 , LEI Zhongjie ^2,3 ,  DU Chunping ^2,3 , QU Yun ^2,3 , WEI Quan ^2,3 , HE Chengqi ^2,3

1. Department of Rehabilitation Medicine, West China Hospital, Sichuan University / West China School of Nursing, Sichuan University, Chengdu, Sichuan 610041, P. R. China;
2. Key Laboratory of Rehabilitation Medicine in Sichuan Province, West China Hospital, Sichuan University, Chengdu, Sichuan 610041, P. R. China;
3. Department of Rehabilitation Medicine, West China Hospital, Sichuan University, Chengdu, Sichuan 610041, P. R. China;

Corresponding author：

DU Chunping, Email: ducp118@163.com

Keywords：

Tracheotomy; multidisciplinary team; extubation; wound care

DOI：

10.7507/1002-0179.202002004

Video：

Export PDF Favorites Scan Get Citation

Abstract Full text Figures/Tables Video References Cited by

Tracheotomy is a commonly used measure in clinical rescue of critically ill patients, and it has an important impact on the survival outcome of patients. The time of extubation directly affects the recovery process of the patient. This article reviews the research progress of extubation management of tracheotomy patients at home and abroad, and mainly summarizes and elaborates from four aspects, including the role of the multidisciplinary team in tracheostomy management, where tracheostomy patients are extubated, conditions for extubation in tracheotomy patients, and wound care after extubation in tracheotomy patients. The purpose is to provide a reference for the selection of extubation timing and extubation management for patients with tracheotomy, to improve the success rate of extubation and improve the quality of life of patients.

Citation： LI Simin, WU Xuyi, WANG Jiao, ZENG Jingru, LEI Zhongjie, DU Chunping, QU Yun, WEI Quan, HE Chengqi. Research progress of extubation management in patients with tracheotomy. West China Medical Journal, 2022, 37(5): 783-787. doi: 10.7507/1002-0179.202002004 Copy

1.	Fischler L, Erhart S, Kleger GR, et al. Prevalence of tracheostomy in ICU patients. A nation-wide survey in Switzerland. Intensive Care Med, 2000, 26(10): 1428-1433.
2.	McGowan SL, Ward EC, Wall LR, et al. UK survey of clinical consistency in tracheostomy management. Int J Lang Commun Disord, 2014, 49(1): 127-138.
3.	Szakmany T. Quality of tracheostomy care is probably as important as timing. Br J Anaesth, 2016, 116(2): 301.
4.	Santus P, Gramegna A, Radovanovic D, et al. A systematic review on tracheostomy decannulation: a proposal of a quantitative semiquantitative clinical score. BMC Pulm Med, 2014, 14: 201.
5.	Singh RK, Saran S, Baronia AK. The practice of tracheostomy decannulation-a systematic review. J Intensive Care, 2017, 5: 38.
6.	Pandian V, Miller CR, Schiavi AJ, et al. Utilization of a standardized tracheostomy capping and decannulation protocol to improve patient safety. Laryngoscope, 2014, 124(8): 1794-1800.
7.	Medeiros GC, Sassi FC, Lirani-Silva C, et al. Criteria for tracheostomy decannulation: literature review. Codas, 2019, 31(6): e20180228.
8.	黄丛萍, 倪莹莹, 章良翔, 等. 持续植物状态气管切开插管两种拔管方式的对照研究. 中国康复医学杂志, 2017, 32(7): 798-801.
9.	柴艳茹, 王元姣, 方瑛. 重症脑损伤气管切开患者拔管时机的研究进展. 国际护理学杂志, 2020, 39(13): 2485-2489.
10.	Mirski MA, Pandian V, Bhatti N, et al. Safety, efficiency, and cost-effectiveness of a multidisciplinary percutaneous tracheostomy program. Crit Care Med, 2012, 40(6): 1827-1834.
11.	Bonvento B, Wallace S, Lynch J, et al. Role of the multidisciplinary team in the care of the tracheostomy patient. J Multidiscip Healthc, 2017, 10: 391-398.
12.	Wilkinson K, Freeth H, Kelly K. ‘On the right trach?’ A review of the care received by patients who undergo tracheostomy. Br J Hosp Med (Lond), 2015, 76(3): 163-165.
13.	Broderick D, Kyzas P, Baldwin AJ, et al. Surgical tracheostomies in COVID-19 patients: a multidisciplinary approach and lessons learned. Oral Oncol, 2020, 106: 104767.
14.	Kim DH, Kang SW, Choi WA, et al. Successful tracheostomy decannulation after complete or sensory incomplete cervical spinal cord injury. Spinal Cord, 2017, 55(6): 601-605.
15.	柴艳茹, 王元姣, 方瑛. 多学科团队协作模式在重症脑损伤气管切开患者拔管中的应用进展. 中西医结合护理(中英文), 2019, 5(10): 206-209.
16.	Steidl C, Bösel J, Suntrup-Krueger S, et al. Tracheostomy, extubation, reintubation: airway management decisions in intubated stroke patients. Cerebrovasc Dis, 2017, 44(1/2): 1-9.
17.	Jaber S, Quintard H, Cinotti R, et al. Risk factors and outcomes for airway failure versus non-airway failure in the intensive care unit: a multicenter observational study of 1514 extubation procedures. Crit Care, 2018, 22(1): 236.
18.	Hernández Martínez G, Rodriguez ML, Vaquero MC, et al. High-flow oxygen with capping or suctioning for tracheostomy decannulation. N Engl J Med, 2020, 383(11): 1009-1017.
19.	Hernández G, Ortiz R, Pedrosa A, et al. The indication of tracheotomy conditions the predictors of time to decannulation in critical patients. Med Intensiva, 2012, 36(8): 531-539.
20.	Canning J, Mills N, Mahadevan M. Pediatric tracheostomy decannulation: when can decannulation be performed safely outside of the intensive care setting? A 10 year review from a single tertiary otolaryngology service. Int J Pediatr Otorhinolaryngol, 2020, 133: 109986.
21.	Diaz-Ballve LP, Villalba DS, Andreu MF, et al. Respiratory muscle strength and state of consciousness values measured prior to the decannulation in different levels of complexity. A longitudinal prospective case series study. Med Intensiva (Engl Ed), 2019, 43(5): 270-280.
22.	杜玉英, 时惠, 任钰. 康复医学科气管切开重症患者影响拔管的多因素分析. 中国康复医学杂志, 2021, 36(6): 670-675.
23.	Cheng L, Mitton K, Walton K, et al. Retrospective analysis of functional and tracheostomy (decannulation) outcomes in patients with brain injury in a hyperacute rehabilitation unit. J Rehabil Med Clin Commun, 2019, 2: 1000024.
24.	Verma R, Mocanu C, Shi J, et al. Decannulation following tracheostomy in children: a systematic review of decannulation protocols. Pediatr Pulmonol, 2021, 56(8): 2426-2443.
25.	宋德婧, 巴文天, 段军, 等. 机械通气患者咳嗽能力的评价及临床意义. 中华医学杂志, 2018, 98(26): 2128-2130.
26.	McGrath BA, Brenner MJ, Warrillow SJ, et al. Tracheostomy in the COVID-19 era: global and multidisciplinary guidance. Lancet Respir Med, 2020, 8(7): 717-725.
27.	Trouillet JL, Collange O, Belafia F, et al. Tracheotomy in the intensive care unit: guidelines from a French expert panel. Ann Intensive Care, 2018, 8(1): 37.
28.	Mah JW, Staff II, Fisher SR, et al. Improving decannulation and swallowing function: a comprehensive, multidisciplinary approach to post-tracheostomy care. Respir Care, 2017, 62(2): 137-143.
29.	Laghi F, Maddipati V, Schnell T, et al. Determinants of cough effectiveness in patients with respiratory muscle weakness. Respir Physiol Neurobiol, 2017, 240: 17-25.
30.	Tornari C, Surda P, Takhar A, et al. Tracheostomy, ventilatory wean, and decannulation in COVID-19 patients. Eur Arch Otorhinolaryngol, 2021, 278(5): 1595-1604.
31.	McGrath BA, Calder N, Laha S, et al. Reduction in harm from tracheostomy-related patient safety incidents following introduction of the National Tracheostomy Safety Project: our experience from two hundred and eighty-seven incidents. Clin Otolaryngol, 2013, 38(6): 541-545.
32.	Shah RK, Lander L, Berry JG, et al. Tracheotomy outcomes and complications: a national perspective. Laryngoscope, 2012, 122(1): 25-29.
33.	Choate K, Barbetti J, Currey J. Tracheostomy decannulation failure rate following critical illness: a prospective descriptive study. Aust Crit Care, 2009, 22(1): 8-15.
34.	Chan LY, Jones AY, Chung RC, et al. Peak flow rate during induced cough: a predictor of successful decannulation of a tracheotomy tube in neurosurgical patients. Am J Crit Care, 2010, 19(3): 278-284.
35.	Duan J, Liu J, Xiao M, et al. Voluntary is better than involuntary cough peak flow for predicting re-intubation after scheduled extubation in cooperative subjects. Respir Care, 2014, 59(11): 1643-1651.
36.	Martin KA, Cole TDK, Percha CM, et al. Standard versus accelerated speaking valve placement after percutaneous tracheostomy: a randomized controlled feasibility study. Ann Am Thorac Soc, 2021, 18(10): 1693-1701.
37.	Enrichi C, Battel I, Zanetti C, et al. Clinical criteria for tracheostomy decannulation in subjects with acquired brain injury. Respir Care, 2017, 62(10): 1255-1263.
38.	Zakrasek EC, Nielson JL, Kosarchuk JJ, et al. Pulmonary outcomes following specialized respiratory management for acute cervical spinal cord injury: a retrospective analysis. Spinal Cord, 2017, 55(6): 559-565.
39.	Manno EM, Rabinstein AA, Wijdicks EF, et al. A prospective trial of elective extubation in brain injured patients meeting extubation criteria for ventilatory support: a feasibility study. Crit Care, 2008, 12(6): R138.
40.	Coplin WM, Pierson DJ, Cooley KD, et al. Implications of extubation delay in brain-injured patients meeting standard weaning criteria. Am J Respir Crit Care Med, 2000, 161(5): 1530-1536.
41.	Gundogdu I, Ozturk EA, Umay E, et al. Implementation of a respiratory rehabilitation protocol: weaning from the ventilator and tracheostomy in difficult-to-wean patients with spinal cord injury. Disabil Rehabil, 2017, 39(12): 1162-1170.
42.	Bianchi A, Barbara M, Monini S. Selective rehabilitative approach to neurological dysfunctions of the oro-pharyngo-laryngeal trivium. Acta Otolaryngol, 2014, 134(11): 1172-1178.
43.	Berney L, Wasserfallen JB, Grant K, et al. Acute neurorehabilitation: does a neurosensory and coordinated interdisciplinary programme reduce tracheostomy weaning time and weaning failure?. NeuroRehabilitation, 2014, 34(4): 809-817.
44.	Pryor L, Ward E, Cornwell P, et al. Patterns of return to oral intake and decannulation post-tracheostomy across clinical populations in an acute inpatient setting. Int J Lang Commun Disord, 2016, 51(5): 556-567.
45.	中华医学会呼吸病学分会呼吸治疗学组. 人工气道气囊的管理专家共识(草案). 中华结核和呼吸杂志, 2014, 37(11): 816-819.
46.	刘玲玲, 尤春景. 脑损伤患者气管切开术后直接拔管的临床研究. 中国康复, 2014(5): 359-361.
47.	徐静, 王建春, 刘双林, 等. 气管切开患者拔管步骤及堵管方法探讨. 中华肺部疾病杂志(电子版), 2016, 9(5): 578-579.
48.	Sella Weiss O, Gvion A, Mcrae J. Speech and language therapists’ management of ventilated patients and patients with tracheostomy in Israel. Int J Lang Commun Disord, 2021: 6.
49.	Thomas S, Sauter W, Starrost U, et al. Time to decannulation and associated risk factors in the postacute rehabilitation of critically ill patients with intensive care unit-acquired weakness: a cohort study. Eur J Phys Rehabil Med, 2017, 53(4): 501-507.
50.	Schneider H, Hertel F, Kuhn M, et al. Decannulation and functional outcome after tracheostomy in patients with severe stroke (DECAST): a prospective observational study. Neurocrit Care, 2017, 27(1): 26-34.
51.	中国吞咽障碍康复评估与治疗专家共识组. 中国吞咽障碍评估与治疗专家共识(2017 年版)第二部分治疗与康复管理篇. 中华物理医学与康复杂志, 2018, 40(1): 1-10.
52.	荆永建. 气管镜在气管切开患者拔管中的应用. 世界最新医学信息文摘(电子版), 2018(85): 78.
53.	Tobin AE, Santamaria JD. An intensivist-led tracheostomy review team is associated with shorter decannulation time and length of stay: a prospective cohort study. Crit Care, 2008, 12(2): R48.
54.	Tawfik KO, Houlton JJ, Compton W, et al. Laryngotracheal reconstruction: a ten-year review of risk factors for decannulation failure. Laryngoscope, 2015, 125(3): 674-679.
55.	唐志明, 温红梅, 许自阳, 等. 喉镜吞咽功能评估指导气管切开合并吞咽障碍患者拔管的应用分析. 中华物理医学与康复杂志, 2020, 42(10): 886-889.
56.	Christiansen KJ, Devantier L, Pasgaard T, et al. Tracheostomy healing time after decannulation. Multidiscip Respir Med, 2022, 16(1): 822.
57.	邓秋霞, 王永红, 王丹丹, 等. 改良气管切开切口换药方法的临床应用效果评价. 护理研究, 2018, 32(23): 3712-3718.
58.	王亚婷. 泡沫敷料在气管切开患者切口换药中的循证护理实践. 广州: 暨南大学, 2017.

1. Fischler L, Erhart S, Kleger GR, et al. Prevalence of tracheostomy in ICU patients. A nation-wide survey in Switzerland. Intensive Care Med, 2000, 26(10): 1428-1433.
2. McGowan SL, Ward EC, Wall LR, et al. UK survey of clinical consistency in tracheostomy management. Int J Lang Commun Disord, 2014, 49(1): 127-138.
3. Szakmany T. Quality of tracheostomy care is probably as important as timing. Br J Anaesth, 2016, 116(2): 301.
4. Santus P, Gramegna A, Radovanovic D, et al. A systematic review on tracheostomy decannulation: a proposal of a quantitative semiquantitative clinical score. BMC Pulm Med, 2014, 14: 201.
5. Singh RK, Saran S, Baronia AK. The practice of tracheostomy decannulation-a systematic review. J Intensive Care, 2017, 5: 38.
6. Pandian V, Miller CR, Schiavi AJ, et al. Utilization of a standardized tracheostomy capping and decannulation protocol to improve patient safety. Laryngoscope, 2014, 124(8): 1794-1800.
7. Medeiros GC, Sassi FC, Lirani-Silva C, et al. Criteria for tracheostomy decannulation: literature review. Codas, 2019, 31(6): e20180228.
8. 黄丛萍, 倪莹莹, 章良翔, 等. 持续植物状态气管切开插管两种拔管方式的对照研究. 中国康复医学杂志, 2017, 32(7): 798-801.
9. 柴艳茹, 王元姣, 方瑛. 重症脑损伤气管切开患者拔管时机的研究进展. 国际护理学杂志, 2020, 39(13): 2485-2489.
10. Mirski MA, Pandian V, Bhatti N, et al. Safety, efficiency, and cost-effectiveness of a multidisciplinary percutaneous tracheostomy program. Crit Care Med, 2012, 40(6): 1827-1834.
11. Bonvento B, Wallace S, Lynch J, et al. Role of the multidisciplinary team in the care of the tracheostomy patient. J Multidiscip Healthc, 2017, 10: 391-398.
12. Wilkinson K, Freeth H, Kelly K. ‘On the right trach?’ A review of the care received by patients who undergo tracheostomy. Br J Hosp Med (Lond), 2015, 76(3): 163-165.
13. Broderick D, Kyzas P, Baldwin AJ, et al. Surgical tracheostomies in COVID-19 patients: a multidisciplinary approach and lessons learned. Oral Oncol, 2020, 106: 104767.
14. Kim DH, Kang SW, Choi WA, et al. Successful tracheostomy decannulation after complete or sensory incomplete cervical spinal cord injury. Spinal Cord, 2017, 55(6): 601-605.
15. 柴艳茹, 王元姣, 方瑛. 多学科团队协作模式在重症脑损伤气管切开患者拔管中的应用进展. 中西医结合护理(中英文), 2019, 5(10): 206-209.
16. Steidl C, Bösel J, Suntrup-Krueger S, et al. Tracheostomy, extubation, reintubation: airway management decisions in intubated stroke patients. Cerebrovasc Dis, 2017, 44(1/2): 1-9.
17. Jaber S, Quintard H, Cinotti R, et al. Risk factors and outcomes for airway failure versus non-airway failure in the intensive care unit: a multicenter observational study of 1514 extubation procedures. Crit Care, 2018, 22(1): 236.
18. Hernández Martínez G, Rodriguez ML, Vaquero MC, et al. High-flow oxygen with capping or suctioning for tracheostomy decannulation. N Engl J Med, 2020, 383(11): 1009-1017.
19. Hernández G, Ortiz R, Pedrosa A, et al. The indication of tracheotomy conditions the predictors of time to decannulation in critical patients. Med Intensiva, 2012, 36(8): 531-539.
20. Canning J, Mills N, Mahadevan M. Pediatric tracheostomy decannulation: when can decannulation be performed safely outside of the intensive care setting? A 10 year review from a single tertiary otolaryngology service. Int J Pediatr Otorhinolaryngol, 2020, 133: 109986.
21. Diaz-Ballve LP, Villalba DS, Andreu MF, et al. Respiratory muscle strength and state of consciousness values measured prior to the decannulation in different levels of complexity. A longitudinal prospective case series study. Med Intensiva (Engl Ed), 2019, 43(5): 270-280.
22. 杜玉英, 时惠, 任钰. 康复医学科气管切开重症患者影响拔管的多因素分析. 中国康复医学杂志, 2021, 36(6): 670-675.
23. Cheng L, Mitton K, Walton K, et al. Retrospective analysis of functional and tracheostomy (decannulation) outcomes in patients with brain injury in a hyperacute rehabilitation unit. J Rehabil Med Clin Commun, 2019, 2: 1000024.
24. Verma R, Mocanu C, Shi J, et al. Decannulation following tracheostomy in children: a systematic review of decannulation protocols. Pediatr Pulmonol, 2021, 56(8): 2426-2443.
25. 宋德婧, 巴文天, 段军, 等. 机械通气患者咳嗽能力的评价及临床意义. 中华医学杂志, 2018, 98(26): 2128-2130.
26. McGrath BA, Brenner MJ, Warrillow SJ, et al. Tracheostomy in the COVID-19 era: global and multidisciplinary guidance. Lancet Respir Med, 2020, 8(7): 717-725.
27. Trouillet JL, Collange O, Belafia F, et al. Tracheotomy in the intensive care unit: guidelines from a French expert panel. Ann Intensive Care, 2018, 8(1): 37.
28. Mah JW, Staff II, Fisher SR, et al. Improving decannulation and swallowing function: a comprehensive, multidisciplinary approach to post-tracheostomy care. Respir Care, 2017, 62(2): 137-143.
29. Laghi F, Maddipati V, Schnell T, et al. Determinants of cough effectiveness in patients with respiratory muscle weakness. Respir Physiol Neurobiol, 2017, 240: 17-25.
30. Tornari C, Surda P, Takhar A, et al. Tracheostomy, ventilatory wean, and decannulation in COVID-19 patients. Eur Arch Otorhinolaryngol, 2021, 278(5): 1595-1604.
31. McGrath BA, Calder N, Laha S, et al. Reduction in harm from tracheostomy-related patient safety incidents following introduction of the National Tracheostomy Safety Project: our experience from two hundred and eighty-seven incidents. Clin Otolaryngol, 2013, 38(6): 541-545.
32. Shah RK, Lander L, Berry JG, et al. Tracheotomy outcomes and complications: a national perspective. Laryngoscope, 2012, 122(1): 25-29.
33. Choate K, Barbetti J, Currey J. Tracheostomy decannulation failure rate following critical illness: a prospective descriptive study. Aust Crit Care, 2009, 22(1): 8-15.
34. Chan LY, Jones AY, Chung RC, et al. Peak flow rate during induced cough: a predictor of successful decannulation of a tracheotomy tube in neurosurgical patients. Am J Crit Care, 2010, 19(3): 278-284.
35. Duan J, Liu J, Xiao M, et al. Voluntary is better than involuntary cough peak flow for predicting re-intubation after scheduled extubation in cooperative subjects. Respir Care, 2014, 59(11): 1643-1651.
36. Martin KA, Cole TDK, Percha CM, et al. Standard versus accelerated speaking valve placement after percutaneous tracheostomy: a randomized controlled feasibility study. Ann Am Thorac Soc, 2021, 18(10): 1693-1701.
37. Enrichi C, Battel I, Zanetti C, et al. Clinical criteria for tracheostomy decannulation in subjects with acquired brain injury. Respir Care, 2017, 62(10): 1255-1263.
38. Zakrasek EC, Nielson JL, Kosarchuk JJ, et al. Pulmonary outcomes following specialized respiratory management for acute cervical spinal cord injury: a retrospective analysis. Spinal Cord, 2017, 55(6): 559-565.
39. Manno EM, Rabinstein AA, Wijdicks EF, et al. A prospective trial of elective extubation in brain injured patients meeting extubation criteria for ventilatory support: a feasibility study. Crit Care, 2008, 12(6): R138.
40. Coplin WM, Pierson DJ, Cooley KD, et al. Implications of extubation delay in brain-injured patients meeting standard weaning criteria. Am J Respir Crit Care Med, 2000, 161(5): 1530-1536.
41. Gundogdu I, Ozturk EA, Umay E, et al. Implementation of a respiratory rehabilitation protocol: weaning from the ventilator and tracheostomy in difficult-to-wean patients with spinal cord injury. Disabil Rehabil, 2017, 39(12): 1162-1170.
42. Bianchi A, Barbara M, Monini S. Selective rehabilitative approach to neurological dysfunctions of the oro-pharyngo-laryngeal trivium. Acta Otolaryngol, 2014, 134(11): 1172-1178.
43. Berney L, Wasserfallen JB, Grant K, et al. Acute neurorehabilitation: does a neurosensory and coordinated interdisciplinary programme reduce tracheostomy weaning time and weaning failure?. NeuroRehabilitation, 2014, 34(4): 809-817.
44. Pryor L, Ward E, Cornwell P, et al. Patterns of return to oral intake and decannulation post-tracheostomy across clinical populations in an acute inpatient setting. Int J Lang Commun Disord, 2016, 51(5): 556-567.
45. 中华医学会呼吸病学分会呼吸治疗学组. 人工气道气囊的管理专家共识(草案). 中华结核和呼吸杂志, 2014, 37(11): 816-819.
46. 刘玲玲, 尤春景. 脑损伤患者气管切开术后直接拔管的临床研究. 中国康复, 2014(5): 359-361.
47. 徐静, 王建春, 刘双林, 等. 气管切开患者拔管步骤及堵管方法探讨. 中华肺部疾病杂志(电子版), 2016, 9(5): 578-579.
48. Sella Weiss O, Gvion A, Mcrae J. Speech and language therapists’ management of ventilated patients and patients with tracheostomy in Israel. Int J Lang Commun Disord, 2021: 6.
49. Thomas S, Sauter W, Starrost U, et al. Time to decannulation and associated risk factors in the postacute rehabilitation of critically ill patients with intensive care unit-acquired weakness: a cohort study. Eur J Phys Rehabil Med, 2017, 53(4): 501-507.
50. Schneider H, Hertel F, Kuhn M, et al. Decannulation and functional outcome after tracheostomy in patients with severe stroke (DECAST): a prospective observational study. Neurocrit Care, 2017, 27(1): 26-34.
51. 中国吞咽障碍康复评估与治疗专家共识组. 中国吞咽障碍评估与治疗专家共识(2017 年版)第二部分治疗与康复管理篇. 中华物理医学与康复杂志, 2018, 40(1): 1-10.
52. 荆永建. 气管镜在气管切开患者拔管中的应用. 世界最新医学信息文摘(电子版), 2018(85): 78.
53. Tobin AE, Santamaria JD. An intensivist-led tracheostomy review team is associated with shorter decannulation time and length of stay: a prospective cohort study. Crit Care, 2008, 12(2): R48.
54. Tawfik KO, Houlton JJ, Compton W, et al. Laryngotracheal reconstruction: a ten-year review of risk factors for decannulation failure. Laryngoscope, 2015, 125(3): 674-679.
55. 唐志明, 温红梅, 许自阳, 等. 喉镜吞咽功能评估指导气管切开合并吞咽障碍患者拔管的应用分析. 中华物理医学与康复杂志, 2020, 42(10): 886-889.
56. Christiansen KJ, Devantier L, Pasgaard T, et al. Tracheostomy healing time after decannulation. Multidiscip Respir Med, 2022, 16(1): 822.
57. 邓秋霞, 王永红, 王丹丹, 等. 改良气管切开切口换药方法的临床应用效果评价. 护理研究, 2018, 32(23): 3712-3718.
58. 王亚婷. 泡沫敷料在气管切开患者切口换药中的循证护理实践. 广州: 暨南大学, 2017.

Previous Article
Research progress on the related mechanisms of facial complex regional pain syndrome
Next Article
以吞咽障碍为首发症状的颈部鳞状细胞癌一例

West China Medical Journal

Research progress of extubation management in patients with tracheotomy

Abstract Full text Figures/Tables Video References Cited by

Previous Article

Next Article

Format

Content