Pediatric tracheostomy decannulation: post implementation of tracheostomy team and decannulation protocol

Lindquist, Samuel; Morrison, Sarah; Iseli, Claire

doi:10.21037/ajo.2020.03.07

Cited by 3 publications

(3 citation statements)

References 24 publications

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“…In the domain of decannulation, the only area of consensus was the need for endoscopic confirmation of airway patency as a means of determining readiness of decannulation. Despite evidence that decannulation protocols can be effective, many centers did not have a decannulation protocol or had a decannulation protocol that applied exclusively to either the ventilated or non‐ventilated tracheostomy population 29–31 . Despite the successes described with some protocols, a systematic review to pediatric decannulation protocols demonstrated significant variability in both the components and success rates of such protocols; this likely explains the significant heterogeneity in decannulation practice observed herein 5 .…”

Section: Discussionmentioning

confidence: 99%

“…Despite evidence that decannulation protocols can be effective, many centers did not have a decannulation protocol or had a decannulation protocol that applied exclusively to either the ventilated or non-ventilated tracheostomy population. [29][30][31] Despite the successes described with some protocols, a systematic review to pediatric decannulation protocols demonstrated significant variability in both the components and success rates of such protocols; this likely explains the significant heterogeneity in decannulation practice observed herein. 5 To that end, successful decannulation protocols have been described in a number of environments utilizing a variety of different investigations [32][33][34] for example successful decannulation in the sleep laboratory in conjunction with PSG was demonstrated by Cristea et al, while Liptzin et al demonstrated successful decannulation in the inpatient setting without the use of PSG.…”

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Chronic tracheostomy care of ventilator‐dependent and ‐independent children: Clinical practice patterns of pediatric respirologists in a publicly funded (Canadian) healthcare system

St‐Laurent

Zielinski

Qazi

et al. 2022

Pediatric Pulmonology

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Objectives: To describe the current clinical practice patterns of Canadian pediatric respirologists at pediatric tertiary care institutions regarding chronic tracheostomy tube care and management of home invasive ventilation. Methods: A pediatric respirologist/pediatrician with expertise in tracheostomy tube care and home ventilation was identified at each Canadian pediatric tertiary care center to complete a 59-item survey of multiple choice and short answer questions. Domains assessed included tracheostomy tube care, caregiver competency and home monitoring, speaking valves, medical management of tracheostomy complications, decannulation, and long-term follow-up. Results: The response rate was 100% (17/17) with all Canadian tertiary care pediatric centers represented and heterogeneity of practice was observed in all domains assessed. For example, though most centers employ Bivona™ (17/17) and Shiley™ (15/17) tracheostomy tubes, variability was observed around tube change, re-use, and cleaning practices. Most centers require two trained caregivers (14/17) and recommend 24/7 eyes on care and oxygen saturation monitoring. Discharge with an emergency tracheostomy kit was universal (17/17). Considerable heterogeneity was observed in the timing and use of speaking valves and speech-language assessment. Inhaled anti-pseudomonal antibiotics are employed by most centers (16/17) though the indication, agent, and protocol varied by center. Though decannulation practices varied considerably, the requirement of upper airway patency was universally required to proceed with decannulation (17/17) independent of ongoing ventilatory support requirements. Conclusion: Considerable variability in pediatric tracheostomy tube care practice exists across Canada. These results will serve as a starting point to standardize and evaluate tracheostomy tube care nationally.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Chronic tracheostomy care of ventilator‐dependent and ‐independent children: Clinical practice patterns of pediatric respirologists in a publicly funded (Canadian) healthcare system

St‐Laurent

Zielinski

Qazi

et al. 2022

Pediatric Pulmonology

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“…Just as polysomnography can be a complementary tool in the decannulation process, inpatient overnight observation and oximetry with capped tracheostomy can be a helpful adjunct before decannulation 37 . Inpatient overnight oximetry is more readily available than polysomnography and can be combined with transcutaneous CO2 monitoring and clinical observation to assess safety and tolerance of capping and readiness for decannulation 18 …”

Section: Con Rebuttalmentioning

confidence: 99%

Pediatric tracheostomy tube decannulation with or without polysomnography: A PRO‐CON debate

Xiao

Amin

Kaspy

et al. 2022

Pediatric Pulmonology

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Determining the timing for decannulation in children with a tracheostomy is a complex process, as the appropriate timing varies based on the initial indication for the tracheostomy tube as well as individual patient characteristics. The original condition for which a tracheostomy was created may improve over time with decannulation being a very important long‐term goal for many families and multidisciplinary teams. However, decannulation is an inherently risky procedure associated with morbidity and mortality. Therefore, careful planning is required to ensure the safety of the procedure. Although routine airway endoscopy is an important component of decannulation protocols, guidelines are less prescriptive regarding the definition of a complete endoscopic airway evaluation and the routine use of polysomnography. This review will summarize the important PRO and CON arguments of integrating polysomnography into pediatric decannulation protocols.

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Pediatric tracheostomy decannulation

Somashekhar¹,

Kumar²,

Basavaraja³

et al. 2023

Journal of Pediatric Critical Care

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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.

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Pediatric tracheostomy decannulation: post implementation of tracheostomy team and decannulation protocol

Cited by 3 publications

References 24 publications

Chronic tracheostomy care of ventilator‐dependent and ‐independent children: Clinical practice patterns of pediatric respirologists in a publicly funded (Canadian) healthcare system

Chronic tracheostomy care of ventilator‐dependent and ‐independent children: Clinical practice patterns of pediatric respirologists in a publicly funded (Canadian) healthcare system

Pediatric tracheostomy tube decannulation with or without polysomnography: A PRO‐CON debate

Pediatric tracheostomy decannulation

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