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01.12.2023 | Original Article

Safety evaluation of a stepwise tracheostomy decannulation program in pediatric patients

verfasst von: Juma Obayashi, Koji Fukumoto, Masaya Yamoto, Hiromu Miyake, Akiyoshi Nomura, Risa Kanai, Yuri Nemoto, Takafumi Tsukui

Erschienen in: Pediatric Surgery International | Ausgabe 1/2023

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Abstract

Purpose

In the event of failed tracheostomy decannulation, patients might have a tragic course of events. We retrospectively evaluated our stepwise tracheostomy decannulation program and examined its safety.

Methods

A 12-year retrospective study of pediatric patients was conducted. The decannulation program was performed on patients who had airway patency by laryngobronchoscopy and whose cannula could be capped during the day. A stepwise decannulation program was performed: continuous 48-h capping trial during hospitalization (Phase 1), removal of the tracheostomy tube for 48 h during hospitalization (Phase 2), and outpatient observation (Phase 3). If a persistent tracheocutaneous fistula existed, the fistula was closed by surgery (Phase 4).

Results

The 77 patients in the study underwent 86 trials. The age at the first time of the decannulation program was 6.5 ± 3.6 years. Sixteen trials failed (18.6%): 8 trials in Phase 1, 2 trials in Phase 2, 4 trials in Phase 3, and 2 trials in Phase 4. Most decannulation failures were due to desaturation in Phase 1/2 and dyspnea in Phase 3/4. The time to reintubation after decannulation was 15–383 days in Phase 3/4.

Conclusions

Patients could fail at every phase of the program, suggesting that a stepwise decannulation program contributes to safety.

Schweiger C, Manica D, Neto JL, Sekine L, Krumenauer R, Caixeta J, Maunsell R, Avelino MG (2020) Determinants of successful tracheostomy decannulation in children: a multicentric cohort study. J Laryngol Otol 134:63–67CrossRefPubMed

Beaton F, Baird T, Clement WA, Kubba H (2016) Tracheostomy decannulation at the Royal Hospital for Sick Children in Glasgow: predictors of success and failure. Int J Pediatr Otorhinolaryngol 90:204–209CrossRefPubMed

Verma R, Mocanu C, Shi J, Miller MR, Chiang J, Wolter NE, Propst EJ, St-Laurent A, Amin R (2021) Decannulation following tracheostomy in children: a systematic review of decannulation protocols. Pediatr Pulmonol 56:2426–2443CrossRefPubMed

Mitchell RB, Hussey HM, Setzen G, Jacobs IN, Nussenbaum B, Dawson C, Brown CA III, Brandt C, Deakins K, Hartnick C (2013) Clinical consensus statement: tracheostomy care. Otolaryngol Head Neck Surg 148:6–20CrossRefPubMed

Wirtz N, Tibesar RJ, Lander T, Sidman J (2016) A pediatric decannulation protocol: outcomes of a 10-year experience. Otolaryngol Head Neck Surg 154:731–734CrossRefPubMed

Kubba H, Cooke J, Hartley B (2004) Can we develop a protocol for the safe decannulation of tracheostomies in children less than 18 months old? Int J Pediatr Otorhinolaryngol 68:935–937CrossRefPubMed

Canning J, Mills N, Mahadevan M (2020) Pediatric tracheostomy decannulation: when can decannulation be performed safely outside of the intensive care setting? A 10 year review from a single tertiary otolaryngology service. Int J Pediatr Otorhinolaryngol 133:109986. https://doi.org/10.1016/j.ijporl.2020.109986CrossRefPubMed

Maslan JT, Feehs KR, Kirse DJ (2017) Considerations for the successful decannulation of the pediatric patient: a single surgeon’s experience. Int J Pediatr Otorhinolaryngol 98:116–120CrossRefPubMed

Lee J, Soma MA, Teng AY, Thambipillay G, Waters KA, Cheng AT (2016) The role of polysomnography in tracheostomy decannulation of the paediatric patient. Int J Pediatr Otorhinolaryngol 83:132–136CrossRefPubMed

10.

Bandyopadhyay A, Cristea AI, Davis SD, Ackerman VL, Slaven JE, Jalou HE, Givan DC, Daftary A (2017) Retrospective analysis of factors leading to pediatric tracheostomy decannulation failure. A single-institution experience. Ann Am Thorac Soc 14:70–75CrossRefPubMedPubMedCentral

11.

Kontzoglou G, Petropoulos I, Noussios G, Skouras A, Benis N, Karagiannidis K (2006) Decannulation in children after long-term tracheostomy. B ENT 1:13–15

12.

Wisniewski BL, Jensen EL, Prager JD, Wine TM, Baker CD (2019) Pediatric tracheocutaneous fistula closure following tracheostomy decannulation. Int J Pediatr Otorhinolaryngol 125:122–127CrossRefPubMed

13.

Azbell CH, Bakeman A, McCoy JL, Tobey AB (2022) Primary versus secondary closure of tracheocutaneous fistula in pediatric patients. Am J Otolaryngol 43:103213. https://doi.org/10.1016/j.amjoto.2021.103213CrossRefPubMed

14.

Wine TM, Simons JP, Mehta DK (2014) Comparison of 2 techniques of tracheocutaneous fistula closure: analysis of outcomes and health care use. JAMA Otolaryngol Head Neck Surg 140:237–242CrossRefPubMed

15.

Wong T, Macpherson O, Docherty S, Gray J, Clement WA, Kubba H (2023) Outcomes and complications of simple layered closure of persistent tracheocutaneous fistula after tracheostomy in childhood. Int J Pediatr Otorhinolaryngol 164:111427. https://doi.org/10.1016/j.ijporl.2022.111427CrossRefPubMed

Titel: Safety evaluation of a stepwise tracheostomy decannulation program in pediatric patients
verfasst von: Juma Obayashi
Koji Fukumoto
Masaya Yamoto
Hiromu Miyake
Akiyoshi Nomura
Risa Kanai
Yuri Nemoto
Takafumi Tsukui
Publikationsdatum: 01.12.2023
Verlag: Springer Berlin Heidelberg
Erschienen in: Pediatric Surgery International / Ausgabe 1/2023
Print ISSN: 0179-0358
Elektronische ISSN: 1437-9813
DOI: https://doi.org/10.1007/s00383-023-05549-0

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Safety evaluation of a stepwise tracheostomy decannulation program in pediatric patients