Variations in conditioning procedures for the decannulation of tracheostomy dependent children: Clinical and theoretical implications.

Abstract

Frequently, tracheostomized children become dependent on breathing through a cannula to such an extent that decannulation becomes difficult if not impossible, even in the absence of evident obstructions. A highly successful program, based on learning principles, for dealing with this problem is reviewed. A number of drawbacks to this program are noted such as lengthy hospitalization and prolonged periods of social isolation of the child. Procedural changes in this program are described which were designed to mitigate these drawbacks. Successful results are presented in the use of this improved program with four tracheostomy dependent children. The theoretical basis for the original program is questioned by the results of the current study and is discussed.