Polysomnography Provides Useful Clinical Information in the Liberation from Respiratory Technology: A Retrospective Review

Abstract

Background The prevalence of respiratory‐technology dependent children is increasing although for most children the goal is liberation from technology. Liberation from home mechanical ventilation (HMV) and decannulation strategies vary due to the lack of clinical practice standards. The primary objective of this study was to describe our practice utilizing a polysomnography (PSG) in the liberation from respiratory‐technology process. Methods Retrospective study of tracheostomized children with and without HMV who underwent an evaluation for decannulation between January 2006 and June 2016. Patient demographics, indication for tracheostomy, indication for PSG, PSG results and interventions performed after the PSG were collected. Results We identified 153 decannulation attempts in 148 children. Ninety‐nine children had a tracheostomy only and 49 children had a tracheostomy with HMV. There were 190 PSGs performed. Almost two‐thirds of the children (N = 92) had at least one PSG, 37 children (25%) had two and 19 children (13%) had more than 2 PSGs. Children with tracheostomy and HMV had more PSGs compared to children with tracheostomy only. PSGs were performed at four points: (1) prior to tracheostomy placement (N = 23); (2) to titrate HMV (N = 19); (3) off‐HMV support (N = 43); and with a capped tracheostomy (N = 101). Most of the off‐HMV PSGs (N = 39) were favorable for discontinuing HMV. About two‐thirds of the capped PSGs (N = 73) were favorable for decannulation; of the unfavorable capped PSGs (N = 28), thirteen required airway surgeries following the unfavorable PSG. Conclusion : Overnight PSG provides useful information to the liberation process, particularly when determining readiness for discontinuing HMV and decannulation.

Respiratory, growth, and survival outcomes of infants with tracheostomy and ventilator dependence

“…8 , 12 It is important to note that those preterm infants with airway anomalies were liberated from the ventilator earlier, as most of them did not have severe lung disease. Since 2013, our practice has incorporated the use of polysomnogram to determine the patient’s favorability for decannulation as reported by Henningsfield et al 27 , 28 As use of polysomnogram was started recently, only 30% of the cohort had a sleep study/polysomnogram prior to decannulation. Additionally, the waiting period to schedule a polysomnogram may have resulted in an unintended delay in the timing of decannulation.…”

Decannulation following tracheostomy in children: A systematic review of decannulation protocols

“…Sixteen studies provided further details regarding capped tube trials. Of these, 6 (38%) studies 16,18,19,26,33 used a stepwise daytime to nocturnal progression over multiple days, 5 (31%) studies 6,21,27,31,32 used a 12 to 24-h capping trial, 3 (19%) studies 22,23,30 used only a single overnight capping trial, 1 (6%) study 13 used a 48-h capping trial, and 1 (6%) study 20 used capping for less than 12 h. Assessment of gas exchange was not reported in six studies. Of the 18 studies reporting gas exchange measurement(s), PSG was used in 13 (72%) studies, oximetry in 10 (56%) studies, blood gases in 3 (17%) studies, and capnography with end-tidal CO 2 in 3 (17%) studies.…”

Comparing decannulation failures and successes in pediatric tracheostomy: An 18‐year experience

“…There are a few small studies showing the value of pre-or postdecannulation polysomnography and airway evaluation by laryngoscopy and bronchoscopy in predicting successful decannulation. [19][20][21][22] Only three patients in the failure group of this study underwent capped polysomnography; therefore, we were unable to assess the value of this intervention before decannulation.…”