Role of Polysomnography in the Development of an Algorithm for Planning Tracheostomy Decannulation

Robison, Jacob G.; Thottam, Prasad John; Greenberg, Laura; Maguire, Raymond C.; Simons, Jeffrey P.; Mehta, Deepak

doi:10.1177/0194599814557467

Cited by 31 publications

(50 citation statements)

References 10 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Based on our results in combination with literature review, we propose an algorithm for weaning nocturnal HMV and decannulation (Figure ). Our algorithm combines the use of daytime capping, and downsizing the tracheostomy to determine readiness for decannulation followed by an overnight capped PSG as a final confirmation.…”

Section: Discussionmentioning

confidence: 92%

“…A capped PSG can help provide the final confirmation that the child is ready for decannulation and is frequently performed prior to decannulation . However, there are no well‐established PSG parameters that correlate with a successful outcome.…”

Section: Discussionmentioning

confidence: 99%

“…Polysomnography has proved valuable in managing tracheostomized children especially to assist with the timing of safe decannulation and is a part of decannulation protocols at many centers . Henningfeld, et al studied 46 children who were successfully liberated from HMV and decannulated.…”

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

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

Bashir

Henningfeld

Thompson

et al. 2018

Pediatric Pulmonology

View full text Add to dashboard Cite

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.

show abstract

Section: Discussionmentioning

confidence: 92%

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

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

Bashir

Henningfeld

Thompson

et al. 2018

Pediatric Pulmonology

View full text Add to dashboard Cite

show abstract

“…Although various protocols have been reported, there is no standardized approach to weaning chronic mechanical ventilation or decannulation in children. 7,8,14–19 …”

mentioning

confidence: 99%

Ventilator weaning and tracheostomy decannulation in children: More than one way

Cristea

Baker

2016

Pediatric Pulmonology

View full text Add to dashboard Cite

“…Compared to our study, other investigators have demonstrated the utility of PSG in predicting decannulation success in pediatric patients with tracheostomy . These studies were not performed in rehabilitation patients and they tended to include younger patients with tracheostomy due to underlying airway abnormalities and pulmonary disorders with only a small proportion having neuromuscular related pathology.…”

Section: Discussionmentioning

confidence: 56%

The role of polysomnography in decannulation of children with brain and spinal cord injuries

Morrow

Tunkel²,

Collaco

et al. 2018

Pediatric Pulmonology

View full text Add to dashboard Cite

Objective: The objective of this retrospective review was to determine the utility of polysomnography (PSG) in influencing the decision to decannulate pediatric patients with brain and spinal cord injuries in an inpatient rehabilitation hospital setting. Methods: Between 2010 and 2016, data were collected on pediatric patients with brain and/or spinal cord injuries who had PSG performed with the goal of decannulation. Patients underwent a decannulation protocol involving toleration of continuous tracheostomy capping and bedside tracheoscopy by otolaryngology. Decision to decannulate was determined with input from multiple disciplines. Associations were examined between decannulation success and findings on PSG as well as demographic factors, injury characteristics, otolaryngology findings, and timeline from initial injury to selected events. Results: A total of 46 patients underwent PSG, after which 38 (83%) were deemed appropriate and eight (17%) were deemed inappropriate for decannulation. Individuals who were deemed ready for decannulation had significantly lower obstructive apnea hypopnea indexes (AHI) (1.7 vs 5.4 events/h, P = 0.03), respiratory disturbance indexes (RDI) (2.4 vs 7.6 events/h, P = 0.006), and peak end tidal carbon dioxide (CO2) levels(50.0 vs 58.7 torr, P = 0.009) on PSG compared to those who were not decannulated. There were no complications following decannulation prior to discharge. Conclusion: PSG provided important additional information as part of a multidisciplinary team assessment of clinical readiness for decannulation in pediatric patients with brain and spinal cord injuries who underwent a decannulation protocol. Obstructive AHI, RDI, and peak end tidal CO2 level were associated with successful decannulation prior to discharge from inpatient rehabilitation.

show abstract

Role of Polysomnography in the Development of an Algorithm for Planning Tracheostomy Decannulation

Cited by 31 publications

References 10 publications

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

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

Ventilator weaning and tracheostomy decannulation in children: More than one way

The role of polysomnography in decannulation of children with brain and spinal cord injuries

Contact Info

Product

Resources

About