Clinical indicators associated with successful tracheostomy cuff deflation

Pryor, Lee N., Ward, Elizabeth C., Cornwell, Petrea L., O'Connor, Stephanie N. and Chapman, Marianne J. (2016) Clinical indicators associated with successful tracheostomy cuff deflation. Australian Critical Care, 29 3: 132-137. doi:10.1016/j.aucc.2016.01.002

Author Pryor, Lee N.
Ward, Elizabeth C.
Cornwell, Petrea L.
O'Connor, Stephanie N.
Chapman, Marianne J.
Title Clinical indicators associated with successful tracheostomy cuff deflation
Journal name Australian Critical Care   Check publisher's open access policy
ISSN 1036-7314
Publication date 2016
Year available 2016
Sub-type Article (original research)
DOI 10.1016/j.aucc.2016.01.002
Open Access Status Not Open Access
Volume 29
Issue 3
Start page 132
End page 137
Total pages 6
Place of publication Philadelphia, PA United States
Publisher Elsevier Ireland
Collection year 2017
Language eng
Formatted abstract

Tracheostomy cuff deflation is a necessary stage of the decannulation pathway, yet the optimal clinical indicators to guide successful cuff deflation are unknown.


The study aims were to identify (1) the proportion of patients tolerating continuous cuff deflation at first attempt; (2) the clinical observations associated with cuff deflation success or failure, including volume of above cuff secretions and (3) the predictive capacity of these observations within a heterogeneous cohort.


A retrospective review of 113 acutely tracheostomised patients with a subglottic suction tube in situ was conducted.


Ninety-five percent of patients (n = 107) achieved continuous cuff deflation on the first attempt. The clinical observations recorded as present in the 24 h preceding cuff deflation included: (1) medical stability, (2) respiratory stability, (3) fraction of inspired oxygen ≤0.4, (4) tracheal suction ≤1–2 hourly, (5) sputum thin and easy to suction, (6) sputum clear or white, (7) ≥moderate cough strength, (8) above cuff secretions ≤1 ml per hour and (9) alertness ≥ eyes open to voice. Using the presence of all 9 indicators as predictors of successful cuff deflation tolerance, specificity and positive predictive value were 100%, although sensitivity was only 77% and negative predictive value 19%. Refinement to a set of 3 clinically driven criteria (medical and respiratory stability, above cuff secretions ≤1 ml/h) provided high specificity (100%), sensitivity (95%), positive predictive value (100%) and an improved negative predictive value (55%).


Key criteria can help guide clinical decision-making on patient readiness for cuff deflation.
Keyword Clinical indicators
Cuff deflation
Subglottic suction
Q-Index Code C1
Q-Index Status Provisional Code
Institutional Status UQ

Document type: Journal Article
Sub-type: Article (original research)
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School of Health and Rehabilitation Sciences Publications
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