Factors Associated With Accidental Decannulation in Tracheostomized Children

Abstract

BACKGROUND: Tracheostomy has many benefits for pediatric patients in the ICU, but it is also associated with complications. Accidental decannulation (AD) is a frequent complication and cause of mortality in this population. Our study aimed to determine the factors associated with AD in tracheostomized pediatric subjects. METHODS: This was a case-control study with 1:2 allocation ratio. Participants were tracheostomized children hospitalized in a prolonged mechanical ventilation hospital between 2013-2018. Each child who experienced decannulation during the study period was included as a case at the time of the event. Controls were obtained from the same population and were defined as subjects without an AD event during the same period. RESULTS: One hundred forty patients were hospitalized at Josefina Martinez Hospital at the time, of whom 41 were selected as cases and 82 as controls. Median (interquartile range) age was 20 (12-36) months, being 60% male. The median time from tracheostomy placement to AD event was 364 (167-731) d. Eighty-four percent of subjects were mechanically ventilated. AD mainly occurred by self-decannulation (53.7%). The risk of AD was higher in children who reached the midline in a sitting position (odds ratio 9.5 [95% CI 1.59253.90]), inner diameter (ID) tracheostomy tube size ^4.0 mm (odds ratio 5.18 [95% CI 1.41219.06]), and who had been hospitalized in hospital rooms with a low ratio of nursing staff for each subject (1 nurse to 4 subjects) (odds ratio 4. 48 [95% CI 1.19216.80]). CONCLUSIONS: Factors associated with a higher risk of AD in tracheostomized children included the ability to reach the midline in a sitting position, the use of a smaller tracheostomy tube (^4.0 mm ID), and lower supervision from staff.

Performance Characterisation of the Airvo2TM Nebuliser Adapter in Combination with the Aerogen SoloTM Vibrating Mesh Nebuliser for in Line Aerosol Therapy during High Flow Nasal Oxygen Therapy

“…The use of VMN incorporated via T-pieces rather than tracheostomy collars was the recommended option. However, there still exists a risk of accidental decannulation from the additional weight on the tracheostomy tube [ 28 ]. The Airvo 2TM system, with its bespoke nebuliser adapter and tracheostomy interface, allows a direct connection of the system to the tracheostomy tube, eliminating the need for additional circuit components, potential decannulation, and unwanted dead space.…”