Study of Decannulation Problems Following Tracheostomy in Quadriplegics

Commonly encountered difficulties during decannulation are tube dependency, bleeding, and mechanical problems with cuff, aspiration, pulmonary complications, tracheomalacia, scarring of the tracheostomy wound, inversion of wound margin in skin, tracheal stenosis and also migration of granulation tissue inside the trachea through the tracheostomy wound. Patients with traumatic quadriplegia following cervical spinal cord injury (CSCI), who cannot self care for their tracheostomy, pose more difficult situations due to paralysis of respiratory muscles, concomitant chest infections, problems of aspiration and the need to care for sacral bed sores. Decannulation in these cases is always a challenge. These patients are generally bed and wheel chair bound, in need of a constant attendant for daily chores and in a state of psychological trauma. In situ tracheostomy tube for prolonged period of time adds to the woes. Removal of tracheostomy tube make them able to communicate verbally, restores their self esteem by removing the dependency on suction apparatus and enabling oral feed and improves their health and quality of life. A prospective observational study was conducted in a tertiary care Spinal Cord Injury Centre (SCIC) of Armed Forces Medical Services of India to understand the decannulation problems in quadriplegic patients of CSCI and to study the causes of difficulties in decannulation in these cases.