Please cite this article in press as: Pryor LN, et al. Clinical indicators associated with successful tracheostomy cuff deflation. Aust Crit Care (2016), http://dx.doi.org/10.1016/j.aucc.2016.01.002 ARTICLE IN PRESS G Model AUCC-308; No. of Pages 6 Australian Critical Care xxx (2016) xxx–xxx Contents lists available at ScienceDirect Australian Critical Care j ourna l h o mepage: www.elsevier.com/locate/aucc Research paper Clinical indicators associated with successful tracheostomy cuff deflation Lee N. Pryor BASc a,b,∗ , Elizabeth C. Ward PhD b,c , Petrea L. Cornwell PhD d,e , Stephanie N. O’Connor MNSc a,f , Marianne J. Chapman MD, PhD a,f a Royal Adelaide Hospital, Intensive Care Unit, SA, Australia b The University of Queensland, School of Health & Rehabilitation Sciences, QLD, Australia c Centre for Functioning & Health Research (CFAHR), QLD, Australia d The Prince Charles Hospital, Metro North Hospital and Health Service, QLD, Australia e School of Applied Psychology, Menzies Health Institute Queensland, Griffith University, QLD, Australia f The University of Adelaide, School of Medicine, SA, Australia a r t i c l e i n f o r m a t i o n Article history: Received 28 August 2015 Received in revised form 9 December 2015 Accepted 12 January 2016 Keywords: Clinical indicators Criteria Cuff deflation Decannulation Subglottic suction Tracheostomy a b s t r a c t Background: Tracheostomy cuff deflation is a necessary stage of the decannulation pathway, yet the optimal clinical indicators to guide successful cuff deflation are unknown. Objectives: 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. Methods: A retrospective review of 113 acutely tracheostomised patients with a subglottic suction tube in situ was conducted. Results: 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%). Conclusions: Key criteria can help guide clinical decision-making on patient readiness for cuff deflation. Crown Copyright © 2016 Published by Elsevier Ltd. on behalf of Australian College of Critical Care Nurses Ltd. All rights reserved. Abbreviations: FiO2, fraction of inspired oxygen; PPV, positive predictive value; NPV, negative predictive value. ∗ Corresponding author at: Speech Pathology Department, Royal Adelaide Hospital, North Terrace, Adelaide, SA 5000, Australia. Tel.: +61 882225524; fax: +61 882225924. E-mail address: lee.pryor@sa.gov.au (L.N. Pryor). 1. Introduction Evidence based criteria for progressing patients with a tracheostomy towards decannulation is limited, despite the proce- dural frequency of tracheostomy tube insertion in intensive care settings. 1 Interpretation of existing research is difficult, in part, due to the heterogeneity of patient populations managed in crit- ical care, 2 as well as the multitude of factors influencing patient outcomes. 3 Furthermore, the majority of existing research has http://dx.doi.org/10.1016/j.aucc.2016.01.002 1036-7314/Crown Copyright © 2016 Published by Elsevier Ltd. on behalf of Australian College of Critical Care Nurses Ltd. All rights reserved.