The low value of pre-decannulation capped overnight ICU monitoring for pediatric patients

Karlic, Kevin J.; Espinosa, N.; Fleming, Brittany E.; Helman, Jennifer; Krawcke, Kelly A.; Thatcher, Aaron L.

doi:10.1016/j.ijporl.2021.110634

Cited by 1 publication

(3 citation statements)

References 6 publications

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“…Of the studies that described their capping protocol, 43% reported daytime capping at home prior to admission for nighttime capping trials [14,11 ▪ ,15]. Tolerance of daytime capping with a lack of obstructive symptoms can be a predictor for successful decannulation [18 ▪ ,26 ▪ ].…”

Section: Tracheostomy Tube Modificationsmentioning

confidence: 99%

“…Notably, in a series of 105 patients, Karlic noted no differences in decannulation success rates in patients that were admitted for an overnight capping trial and those that were not, leading to a recommendation against an overnight capping trial for most patients. They propose obtaining a capped sleep study in those who are medically or structurally complex [26 ▪ ].…”

Section: Tracheostomy Tube Modificationsmentioning

confidence: 99%

“…Over the last decade, reported decannulation success rates vary from 84% to 100% [3,4 ▪▪ ,5,6 ▪ ,7 ▪ ,8,9 ▪ ,10 ▪ ,11 ▪ ,12,13–17,18 ▪ ]. Though there is variability in decannulation protocols based on patient population or institutional resources, there is strong support in the literature for explicitly described institutional protocols for decannulation [1,3,4 ▪▪ ,5,6 ▪ ,7 ▪ ,8,9 ▪ –11 ▪ ,12–17,18 ▪ ,19,20,26 ▪ ,27 ▪ ,29,30]. This article will provide a review of published decannulation protocols over the past 10 years…”

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Pediatric tracheostomy decannulation: what's the evidence?

Raynor,

Bedwell

2023

Current Opinion in Otolaryngology &Amp; Head &Amp; Neck Surgery

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Purpose of review 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. Recent findings 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. Summary 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.

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Section: Tracheostomy Tube Modificationsmentioning

confidence: 99%

Section: Tracheostomy Tube Modificationsmentioning

confidence: 99%