Pediatric tracheostomy decannulation: what's the evidence?
Journal
Current opinion in otolaryngology & head and neck surgery
ISSN: 1531-6998
Titre abrégé: Curr Opin Otolaryngol Head Neck Surg
Pays: United States
ID NLM: 9417024
Informations de publication
Date de publication:
01 Dec 2023
01 Dec 2023
Historique:
medline:
3
11
2023
pubmed:
26
9
2023
entrez:
26
9
2023
Statut:
ppublish
Résumé
Pediatric decannulation failure can be associated with large morbidity and mortality, yet there are no published evidence-based guidelines for pediatric tracheostomy decannulation. Tracheostomy is frequently performed in medically complex children in whom it can be difficult to predict when and how to safely decannulate. Published studies regarding pediatric decannulation are limited to reviews and case series from single institutions, with varying populations, indications for tracheostomy, and institutional resources. This article will provide a review of published decannulation protocols over the past 10 years. Endoscopic airway evaluation is required to assess the patency of the airway and address any airway obstruction prior to decannulation. There is considerable variability in tracheostomy tube modification between published protocols, though the majority support a capping trial and downsizing of the tracheostomy tube to facilitate capping. Most protocols include overnight capping in a monitored setting prior to decannulation with observation ranging from 24 to 48 h after decannulation. There is debate regarding which patients should have capped polysomnography (PSG) prior to decannulation, as this exam is resource-intensive and may not be widely available. Persistent tracheocutaneous fistulae are common following decannulation. Excision of the fistula tract with healing by secondary intention has a lower reported operative time, overall complication rate, and postoperative length of stay. Pediatric decannulation should occur in a stepwise process. The ideal decannulation protocol should be safe and expedient, without utilizing excessive healthcare resources. There may be variability in protocols based on patient population or institutional resources, but an explicitly described protocol within each institution is critical to consistent care and quality improvement over time. Further research is needed to identify selection criteria for who would most benefit from PSG prior to decannulation to guide allocation of this limited resource.
Identifiants
pubmed: 37751378
doi: 10.1097/MOO.0000000000000929
pii: 00020840-990000000-00087
doi:
Types de publication
Review
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
397-402Informations de copyright
Copyright © 2023 Wolters Kluwer Health, Inc. All rights reserved.
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