Comparison Between Immediate and Gradual Decannulation

NCT ID: NCT02469909

Last Updated: 2017-03-03

Study Results

Results pending

The study team has not published outcome measurements, participant flow, or safety data for this trial yet. Check back later for updates.

Basic Information

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Recruitment Status

UNKNOWN

Clinical Phase

NA

Total Enrollment

100 participants

Study Classification

INTERVENTIONAL

Study Start Date

2015-06-30

Study Completion Date

2019-01-31

Brief Summary

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The investigators propose to examine the feasibility and safety of immediate (single stage) decannulation in adult patients in a controlled randomized trial. Patients who will be found fit for decannulation after an otolaryngologist and intensive care specialist assessment will be randomized into two groups: immediate decannulation and gradual decrease in cannula size. Both groups of patients will be monitored after decannulation and in the outpatient clinic for any complications following the procedure.

Detailed Description

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Recruitment of the patients will be demands for decannulation evaluation of different departments in our institution. All patients who will agree to participate in the study and meet the inclusion criteria would undergo three major steps"

1. Pre decannulation evaluation by otolaryngologist and intensive care specialist following inclusion criteria.
2. Decannulation:

In the immediate decannulation group - the tracheostomy tube is removed and the patient would be monitored overnight in an intermediate monitored unit. On the next day a clinical evaluation would be held, and the patient would be discharge or transferred to his department according to the clinical course of the patient.

In the gradual decannulation group:

The tracheostomy tube will be reduced in 2 sizes compared with the initial inner diameter of the tube. The patients will remain with the reduced tube for 48 hours, and the tube will be removed if the patients would meet pre-decannulation evaluation.
3. Follow up:

All patients would be followed in 7, 30, 90 days following decannulation in the outpatient clinic or in their departments if still hospitalized. In these visit questionnaires regarding possible respiratory complications will be documented.

Conditions

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Tracheostomy

Study Design

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Allocation Method

RANDOMIZED

Intervention Model

PARALLEL

Primary Study Purpose

TREATMENT

Blinding Strategy

NONE

Study Groups

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immediate decannulation

In the immediate decannulation group - the tracheostomy tube is removed and the patient would be monitored overnight in an intermediate monitored unit. On the next day a clinical evaluation would be held, and the patient would be discharge or transferred to his department according to the clinical course of the patient

Group Type OTHER

Overnight observation

Intervention Type OTHER

patients in the immediate decannulation group would be admitted for an overnight in intensive care unit or the otolaryngology department. they would be monitored for any respiratory or airway complications.

Pre-discharge evaluation

Intervention Type OTHER

After an overnight observation, patients in the immediate decannulation group would would undergo clinical and laboratory evaluation including vital signs and blood gases.

outpatient clinic follow ups

Intervention Type OTHER

all patients would visit the otolaryngology outpatient clinic in 7, 30 and 90 days following decannulation for an evaluation of any respiratory complications following decannulation

immediate decannulation

Intervention Type PROCEDURE

the tracheostomy tube is removed at once

Gradual tracheostomy tube decrease

In the gradual decannulation group The tracheostomy tube will be reduced in 2 sizes compared with the initial inner diameter of the tube. The patients will remain with the reduced tube for 48 hours, and the tube will be removed if the patients would meet pre-decannulation evaluation

Group Type OTHER

outpatient clinic follow ups

Intervention Type OTHER

all patients would visit the otolaryngology outpatient clinic in 7, 30 and 90 days following decannulation for an evaluation of any respiratory complications following decannulation

Gradual tracheostomy tube decrease

Intervention Type PROCEDURE

The tracheostomy tube will be reduced in 2 sizes compared with the initial inner diameter of the tube. The patients will remain with the reduced tube for 48 hours, and the tube will be removed if the patients would meet pre-decannulation evaluation

Interventions

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Overnight observation

patients in the immediate decannulation group would be admitted for an overnight in intensive care unit or the otolaryngology department. they would be monitored for any respiratory or airway complications.

Intervention Type OTHER

Pre-discharge evaluation

After an overnight observation, patients in the immediate decannulation group would would undergo clinical and laboratory evaluation including vital signs and blood gases.

Intervention Type OTHER

outpatient clinic follow ups

all patients would visit the otolaryngology outpatient clinic in 7, 30 and 90 days following decannulation for an evaluation of any respiratory complications following decannulation

Intervention Type OTHER

immediate decannulation

the tracheostomy tube is removed at once

Intervention Type PROCEDURE

Gradual tracheostomy tube decrease

The tracheostomy tube will be reduced in 2 sizes compared with the initial inner diameter of the tube. The patients will remain with the reduced tube for 48 hours, and the tube will be removed if the patients would meet pre-decannulation evaluation

Intervention Type PROCEDURE

Eligibility Criteria

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Inclusion Criteria

Patients who underwent tracheostomy with the following conditions:

1. Tracheostomy tract is established more than 7 days
2. Normal vital signs: heart rate 50-100, 90\<systolic BP \<180, respiratory rate \<20. Saturation \>90% in room air
3. Effective cough
4. Normal swallows \\ feeding possibility
5. \# steps endoscopy test: through the tracheostomy tube, normal naso-laryngeal and through the tract with an upper look towards the subglottic area in order to detect subglottic stenosis.
6. Ability of the patient to breath with a capped cannula.

Exclusion Criteria

* Patients with a major complication in tracheostomy procedure (subcutaneous emphysema, pneumothorax, bleeding, false root)
* patient with anatomical neck abnormality
* Pregnant women
Minimum Eligible Age

18 Years

Eligible Sex

ALL

Accepts Healthy Volunteers

No

Sponsors

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Soroka University Medical Center

OTHER

Sponsor Role collaborator

Kaplan Medical Center

OTHER

Sponsor Role lead

Responsible Party

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Dr Oded Cohen

Dr Oded Cohen

Responsibility Role PRINCIPAL_INVESTIGATOR

Principal Investigators

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Nili Segal, Dr

Role: PRINCIPAL_INVESTIGATOR

Soroka hospital

Locations

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Kaplan medical center

Rehovot, Rehovot, Israel

Site Status RECRUITING

Countries

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Israel

Central Contacts

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Oded Cohen, Dr

Role: CONTACT

+972-544682490

Yaara Haimovich

Role: CONTACT

+972-52-8580806

Facility Contacts

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Oded Cohen, Dr

Role: primary

+972-54-468-2490

Yaara Haimovich

Role: backup

+972-528580806

References

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Epstein SK. Anatomy and physiology of tracheostomy. Respir Care. 2005 Apr;50(4):476-82.

Reference Type BACKGROUND
PMID: 15807905 (View on PubMed)

Delaney A, Bagshaw SM, Nalos M. Percutaneous dilatational tracheostomy versus surgical tracheostomy in critically ill patients: a systematic review and meta-analysis. Crit Care. 2006;10(2):R55. doi: 10.1186/cc4887.

Reference Type BACKGROUND
PMID: 16606435 (View on PubMed)

Pierson DJ. Tracheostomy and weaning. Respir Care. 2005 Apr;50(4):526-33.

Reference Type BACKGROUND
PMID: 15807916 (View on PubMed)

Christopher KL. Tracheostomy decannulation. Respir Care. 2005 Apr;50(4):538-41.

Reference Type BACKGROUND
PMID: 15807918 (View on PubMed)

Heffner JE. The technique of weaning from tracheostomy. Criteria for weaning; practical measures to prevent failure. J Crit Illn. 1995 Oct;10(10):729-33.

Reference Type BACKGROUND
PMID: 10155745 (View on PubMed)

Lewarski JS. Long-term care of the patient with a tracheostomy. Respir Care. 2005 Apr;50(4):534-7.

Reference Type BACKGROUND
PMID: 15807917 (View on PubMed)

Mitchell RB, Hussey HM, Setzen G, Jacobs IN, Nussenbaum B, Dawson C, Brown CA 3rd, Brandt C, Deakins K, Hartnick C, Merati A. Clinical consensus statement: tracheostomy care. Otolaryngol Head Neck Surg. 2013 Jan;148(1):6-20. doi: 10.1177/0194599812460376. Epub 2012 Sep 18.

Reference Type RESULT
PMID: 22990518 (View on PubMed)

De Leyn P, Bedert L, Delcroix M, Depuydt P, Lauwers G, Sokolov Y, Van Meerhaeghe A, Van Schil P; Belgian Association of Pneumology and Belgian Association of Cardiothoracic Surgery. Tracheotomy: clinical review and guidelines. Eur J Cardiothorac Surg. 2007 Sep;32(3):412-21. doi: 10.1016/j.ejcts.2007.05.018. Epub 2007 Jun 27.

Reference Type RESULT
PMID: 17588767 (View on PubMed)

Other Identifiers

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ENTK 34-CTIL

Identifier Type: -

Identifier Source: org_study_id

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