Clinical Assessment and Measurement of Tracheal Pressures in Decision Making During the Decannulation Process in Adult Patients. Agreement Study
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Abstract
Introduction: Tracheostomy tube manometry provides objective data on upper airway patency and can guide clinical decision-making. However, at our institution, discrepancies persist among healthcare professionals regarding the necessity of tracheal pressure measurement versus relying solely on clinical assessment.
The aim of this study was to evaluate the level of concordance in therapeutic decision-making during the decannulation process based on clinical assessment—performed by expert and non-expert professionals—and tracheal pressure measurements.
Materials and methods: This concordance study included tracheostomized adults aged 18 years and older, admitted to respiratory care units between 2021 and 2023. Clinical assessments were compared with tracheal pressure measurements to determine agreement in decannulation decisions.
Results: Agreement between decisions based on tracheal pressure measurements and clinical assessment was almost perfect for experts (κ = 0.91; 95% CI, 0.83–0.94; p < 0.0001) and moderate for non-experts (κ = 0.42; 95% CI, 0.14–0.72; p = 0.02).
Conclusion: Clinical assessment by expert professionals demonstrates almost perfect concordance with objective tracheal pressure measurements in therapeutic decision-making during decannulation. In contrast, for non-expert professionals, tracheal pressure measurement serves as a crucial adjunct to clinical evaluation, helping to align their decisions with those of experts.
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