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：

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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.	黃叢萍, 倪瑩瑩, 章良翔, 等. 持續植物狀態氣管切開插管兩種拔管方式的對照研究. 中國康復醫學雜志, 2017, 32(7): 798-801.
9.	柴艷茹, 王元姣, 方瑛. 重癥腦損傷氣管切開患者拔管時機的研究進展. 國際護理學雜志, 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.	柴艷茹, 王元姣, 方瑛. 多學科團隊協作模式在重癥腦損傷氣管切開患者拔管中的應用進展. 中西醫結合護理(中英文), 2019, 5(10): 206-209.
16.	Steidl C, B?sel 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, 時惠, 任鈺. 康復醫學科氣管切開重癥患者影響拔管的多因素分析. 中國康復醫學雜志, 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, 段軍, 等. 機械通氣患者咳嗽能力的評價及臨床意義. 中華醫學雜志, 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.	中華醫學會呼吸病學分會呼吸治療學組. 人工氣道氣囊的管理專家共識(草案). 中華結核和呼吸雜志, 2014, 37(11): 816-819.
46.	劉玲玲, 尤春景. 腦損傷患者氣管切開術后直接拔管的臨床研究. 中國康復, 2014(5): 359-361.
47.	徐靜, 王建春, 劉雙林, 等. 氣管切開患者拔管步驟及堵管方法探討. 中華肺部疾病雜志(電子版), 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.	中國吞咽障礙康復評估與治療專家共識組. 中國吞咽障礙評估與治療專家共識(2017 年版)第二部分治療與康復管理篇. 中華物理醫學與康復雜志, 2018, 40(1): 1-10.
52.	荊永建. 氣管鏡在氣管切開患者拔管中的應用. 世界最新醫學信息文摘(電子版), 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, 溫紅梅, 許自陽, 等. 喉鏡吞咽功能評估指導氣管切開合并吞咽障礙患者拔管的應用分析. 中華物理醫學與康復雜志, 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.	鄧秋霞, 王永紅, 王丹丹, 等. 改良氣管切開切口換藥方法的臨床應用效果評價. 護理研究, 2018, 32(23): 3712-3718.
58.	王亞婷. 泡沫敷料在氣管切開患者切口換藥中的循證護理實踐. 廣州: 暨南大學, 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. 黃叢萍, 倪瑩瑩, 章良翔, 等. 持續植物狀態氣管切開插管兩種拔管方式的對照研究. 中國康復醫學雜志, 2017, 32(7): 798-801.
9. 柴艷茹, 王元姣, 方瑛. 重癥腦損傷氣管切開患者拔管時機的研究進展. 國際護理學雜志, 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. 柴艷茹, 王元姣, 方瑛. 多學科團隊協作模式在重癥腦損傷氣管切開患者拔管中的應用進展. 中西醫結合護理(中英文), 2019, 5(10): 206-209.
16. Steidl C, B?sel 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, 時惠, 任鈺. 康復醫學科氣管切開重癥患者影響拔管的多因素分析. 中國康復醫學雜志, 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, 段軍, 等. 機械通氣患者咳嗽能力的評價及臨床意義. 中華醫學雜志, 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. 中華醫學會呼吸病學分會呼吸治療學組. 人工氣道氣囊的管理專家共識(草案). 中華結核和呼吸雜志, 2014, 37(11): 816-819.
46. 劉玲玲, 尤春景. 腦損傷患者氣管切開術后直接拔管的臨床研究. 中國康復, 2014(5): 359-361.
47. 徐靜, 王建春, 劉雙林, 等. 氣管切開患者拔管步驟及堵管方法探討. 中華肺部疾病雜志(電子版), 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. 中國吞咽障礙康復評估與治療專家共識組. 中國吞咽障礙評估與治療專家共識(2017 年版)第二部分治療與康復管理篇. 中華物理醫學與康復雜志, 2018, 40(1): 1-10.
52. 荊永建. 氣管鏡在氣管切開患者拔管中的應用. 世界最新醫學信息文摘(電子版), 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, 溫紅梅, 許自陽, 等. 喉鏡吞咽功能評估指導氣管切開合并吞咽障礙患者拔管的應用分析. 中華物理醫學與康復雜志, 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. 鄧秋霞, 王永紅, 王丹丹, 等. 改良氣管切開切口換藥方法的臨床應用效果評價. 護理研究, 2018, 32(23): 3712-3718.
58. 王亞婷. 泡沫敷料在氣管切開患者切口換藥中的循證護理實踐. 廣州: 暨南大學, 2017.

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