Can we develop a protocol for the safe decannulation of tracheostomies in children less than 18 months old?

Performance of a tracheostomy removal protocol for pediatric patients in rehabilitation after acquired brain injury: Factors associated with timing and possibility of decannulation

“…The absence of decannulation failures seems to support the usefulness of this approach.Aside from physical obstructions, problems connected with neurological disability are also important. The main factor that postponed or prevented decannulation in our sample was the insufficient ability to manage secretions, leading to accumulation of secretions in the hypopharynx, visible through fiberoptic endoscopy.The inadequate management of secretions translates into the intolerance of tracheostomy caps, which has been previously considered as a marker of decannulation risk28 ; our data further support the role of secretion management, as reflected by the influence of both dysphagia and respiratory complications on the timing and possibility of decannulation. Indeed, all of our patients who could never be considered eligible for decannulation displayed persistent respiratory complications; similarly, in patients with residual respiratory complications decannulation was postponed from the first stay to the follow-up period, as reflected also by regression data.Although for the sake of statistical analysis, we clustered together all forms of dysphagia and of respiratory complications, it is worth specifying their nature and severity, since low-grade dysphagia and/or respiratory issues may persist also among decannulated patients.…”

Tracheostomy in Infants and Children

“…Although a size 2.5 tracheostomy tube is available, its lumen is so small that it is rarely used outside of a hospital setting due to the concern for mucous plugging of the tube and difficulty suctioning, a potentially fatal complication. 94,96 Airway Evaluation. The importance of a formal airway evaluation, direct laryngobronchoscopy, before decannulation under general anesthesia is not disputed.…”

“…A direct laryngobronchoscopy evaluates airway patency at all levels and is necessary for not only diagnostic evaluation but also therapeutic treatment of the airway. Spontaneous ventilation during this procedure with the tracheostomy removed from 90 35 Decannulation at airway endoscopy if suitable; conservative approach to resource utilization 94.2 2015 Robison et al 87 28 Role of PSG as useful adjunct; AHI Ͻ 2.75 predictor of successful decannulation 71.4 2015 Gurbani et al 93 59 AHI and end-tidal CO 2 good predictors of decannulation; using both favorable MLB and PSG to predict decannulation NA 2015 Prickett et al 88 46 In-patient observation for a 24-h asymptomatic interval after decannulation is sufficient 91 2013 Mitchell et al 86 Recommendations regarding suitability for decannulation and capping (Ͼ 2 y) NA 2004 Kubba et al 94 4 Modified protocol in Ͻ 13 months; downsize to size 2 tube in small infants NA 1999 Mukherjee et al 95 31 PSG is a useful adjunct to evaluating readiness for decannulation in children 67.7 1997 Waddell et al 96 84 Determine minimum safe duration of in-patient stay 79 (first attempt) 1997 Merritt et al 97 10 1-17 y), wherein they recommended direct laryngobronchoscopy with intraoperative decannulation, in the absence of tube downsizing, a capping trial, or PSG. If the airway was deemed adequate at the time of direct laryngobronchoscopy, the tracheostomy tube was removed, and the child was monitored overnight and discharged the following day if no complications arose.…”

Pediatric Tracheotomy: Process Management from Indication to Decanulation

“…Bu sebeple güvenli ve uygun dekanülasyonu sağlayabilmek için çeşitli algoritmalar oluşturulmuştur. 47,48 Pediatrik trakeotomilerde genel olarak dekanülasyon oranları %30'lardadır. 5 Bu oranı belirleyen en önemli sebep, altta yatan hastalığın progresif olması ve mekanik ventilatör ihtiyacıdır.…”