Pediatric tracheostomy decannulation

Abstract

Background: Advances in neonatal and pediatric intensive care have increased the number of children who survive with disabilities. The management of the tracheostomized child is a complex and demanding assignment as they have higher rates of complications. Ideally, the decannulation process should proceed once the child no longer requires mechanical ventilation and the underlying pathology has resolved or been reversed. This study highlights our experience in managing pediatric tracheostomy decannulation at a tertiary care center. Subjects and Methods: This was a single-center, prospective study conducted at the tertiary care pediatric hospital for a period of 1 year. Children with tracheostomy in situ who got admitted for laryngotracheobronchoscopy and decannulation were included. Results: Indication of tracheostomy was broadly divided into reasons causing upper airway obstruction and those requiring prolonged intubation. It showed that 82% were due to prolonged intubation, in which 85.3% were due to neurological reasons. The success rate for decannulation was 97%. Age of child, duration of intubation, posttracheostomy period, and type of tracheostomy tube had no significant correlation with outcome of tracheostomy decannulation. Conclusions: Resolution of primary indication for tracheostomy is required before planning of tracheotomy decannulation. Bronchoscopic airway evaluation and decannulation trial in operation theater is needed for successful decannulation. There was no impact of age, duration of intubation, posttracheostomy period, and type of tracheostomy tube on the outcome of tracheostomy decannulation.

Pediatric tracheostomy decannulation: what's the evidence?

“…Henningfield reported that 65% of patients required surgery for airway obstruction prior to decannulation, namely adenotonsillectomy (45%), removal of suprastomal granulomas (41%) and laryngotracheal reconstruction (LTR) (20%) [17]. The reported frequency of suprastomal granuloma removal prior to decannulation varies from 16% to 41% [3,6 ▪ ,11 ▪ ,17,16,15].…”

“…Published studies are limited to reviews and case series from single institutions, with varying populations, indications for tracheostomy, and institutional resources. Over the last decade, reported decannulation success rates vary from 84% to 100% [3,4 ▪▪ ,5,6 ▪ ,7 ▪ ,8,9 ▪ ,10 ▪ ,11 ▪ ,12,13–17,18 ▪ ]. Though there is variability in decannulation protocols based on patient population or institutional resources, there is strong support in the literature for explicitly described institutional protocols for decannulation [1,3,4 ▪▪ ,5,6 ▪ ,7 ▪ ,8,9 ▪ –11 ▪ ,12–17,18 ▪ ,19,20,26 ▪ ,27 ▪ ,29,30].…”

“…Over the last decade, reported decannulation success rates vary from 84% to 100% [3,4 ▪▪ ,5,6 ▪ ,7 ▪ ,8,9 ▪ ,10 ▪ ,11 ▪ ,12,13–17,18 ▪ ]. Though there is variability in decannulation protocols based on patient population or institutional resources, there is strong support in the literature for explicitly described institutional protocols for decannulation [1,3,4 ▪▪ ,5,6 ▪ ,7 ▪ ,8,9 ▪ –11 ▪ ,12–17,18 ▪ ,19,20,26 ▪ ,27 ▪ ,29,30]. This article will provide a review of published decannulation protocols over the past 10 years…”