A Simplified Protocol for Tracheostomy Decannulation in Patients Weaned off Prolonged Mechanical Ventilation

Abstract Introduction The criteria for the removal of the tracheostomy tube (decannulation) vary from center to center. Some perform an endoscopic evaluation under anesthesia or computed tomography, which adds to the cost and discomfort. We use a simple two-part protocol to determine the eligibility and carry out the decannulation: part I consists of airway and swallowing assessment through an office-based flexible laryngotracheoscopy, and part II involves a tracheostomy capping trial. Objective The primary objective was to determine the safety and efficacy of the simplified decannulation protocol followed at our center among the patients who were weaned off the mechanical ventilator and exhibited good swallowing function clinically. Methods Of the patients considered for decannulation between November 1st, 2018, and October 31st, 2020, those who had undergone tracheostomy for prolonged mechanical ventilation were included. The efficacy to predict successful decannulation was calculated by the decannulation rate among patients who had been deemed eligible for decannulation in part I of the protocol, and the safety profile was defined by the protocol's ability to correctly predict the chances of risk-free decannulation among those submitted to part II of the protocol. Results Among the 48 patients included (mean age: 46.5 years; male-to-female ratio: 3:1), the efficacy of our protocol in predicting the successful decannulation was of 87.5%, and it was was safe or reliable in 95.45%. Also, in our cohort, the decannulation success and the duration of tracheotomy dependence were significantly affected by the neurological status of the patients. Conclusion The decannulation protocol consisting of office-based flexible laryngotracheoscopy and capping trial of the tracheostomy tube can safely and effectively aid the decannulation process.

Intraductal pseudopodia in pleomorphic adenoma of parotid gland

Pleomorphic adenoma is the most common salivary gland tumor. Pseudopodia are finger-like projections extending beyond the tumor capsule, seen in pleomorphic adenoma. If not resected completely, these pseudopodia may increase the risk of recurrence after excision of pleomorphic adenoma. While performing a total conservative parotidectomy for the pleomorphic adenoma of the parotid gland, we encountered tumor in the Stensen's duct. On pathological examination, the tumor was not involving the wall of the duct but was passing through the lumen, like a pseudopod. During parotidectomy, the surgeon should inspect the lumen of parotid duct for the presence of any tumor. Pseudopodia of pleomorphic adenoma may extend into the lumen and if not addressed adequately may lead to recurrence of the tumor.