The Role of Polysomnography in Tracheostomy Decannulation of Children with Bronchopulmonary Dysplasia

Quinlan, Courtney M; Piccione, J.C.; Beck, Suzanne E.; Brooks, Lee J.; Patel, Reema; Kim, J.Y.; Escobar, Emma; Afolabi‐Brown, Olufunke

doi:10.1164/ajrccm-conference.2019.199.1_meetingabstracts.a3885

Cited by 2 publications

(6 citation statements)

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“…Previous studies have attempted to identify favorable PSG parameters predictive of successful decannulation, such as Lee et alwho found that total apnea-hypopnea index (AHI) was significantly lower in children who had successful decannulation versus those who could not be decannulated (3.35/h vs. 18.5/h, p < .05) 22. Similar findings were reported by Quinlan et al16 However, other studies have not demonstrated clear associations between PSG findings and decannulation outcomes. For example, Tunkel et al33 reported a decannulation failure in a child with favourable PSG results.…”

supporting

confidence: 70%

“…However, only three protocols monitored children for the 24-48-h period suggested by the ATS. 6,15,16 Some authors suggest that shorter observation periods are safe and promote resource conservation. For example, Prickett and Sobol 26 found that all decannulation failures in their study occurred within the first 12 h. Observation typically occurred on the inpatient ward or ICU setting.…”

Section: Discussionmentioning

confidence: 99%

“…Sixteen studies provided further details regarding capped tube trials. Of these, 6 (38%) studies 16,18,19,26,33 used a stepwise daytime to nocturnal progression over multiple days, 5 (31%) studies 6,21,27,31,32 used a 12 to 24-h capping trial, 3 (19%) studies 22,23,30 used only a single overnight capping trial, 1 (6%) study 13 used a 48-h capping trial, and 1 (6%) study 20 used capping for less than 12 h. Assessment of gas exchange was not reported in six studies. Of the 18 studies reporting gas exchange measurement(s), PSG was used in 13 (72%) studies, oximetry in 10 (56%) studies, blood gases in 3 (17%) studies, and capnography with end-tidal CO 2 in 3 (17%) studies.…”

Section: Decannulation Protocolsmentioning

confidence: 99%

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Decannulation following tracheostomy in children: A systematic review of decannulation protocols

Verma

Mocanu

Shi

et al. 2021

Pediatric Pulmonology

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Objective: To provide a systematic review of the existing pediatric decannulation protocols, including the role of polysomnography, and their clinical outcomes.Methods: Five online databases were searched from database inception to May 29, 2020. Study inclusion was limited to publications that evaluated tracheostomy decannulation in children 18 years of age and younger. Data extracted included patient demographics and primary indication for tracheostomy. Methods used to assess readiness for decannulation were noted including the use of bronchoscopy, tracheostomy tube modifications, and gas exchange measurements. After decannulation, details regarding mode of ventilation, location, and length of observation period, and clinical outcomes were also collected. Descriptive statistical analyses were performed.Results: A total of 24 studies including 1395 children were reviewed.Tracheostomy indications included upper airway obstruction at a well-defined anatomic site (35%), upper airway obstruction not at a well-defined site (12%) and need for long-term ventilation and pulmonary care (53%). Bronchoscopy was routinely used in 23 of 24 (96%) protocols. Tracheostomy tube modifications in the protocols included capping (n = 20, 83%), downsizing (n = 14, 58%), and fenestrations (n = 2, 8%). Measurements of gas exchange included polysomnography (n = 13/18, 72%), oximetry (n = 10/18, 56%), blood gases (n = 3,17%), and capnography (n = 3, 17%). After decannulation, children in 92% of protocols were transitioned to room air. Observation period of 48 h or less was used in 76% of children.Conclusions: There exists large variability in pediatric decannulation protocols.Polysomnography plays an integral role in assessing most children for tracheostomy removal. Evidence-based guidelines to standardize pediatric tracheostomy care remain an urgent priority.

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supporting

confidence: 70%

Section: Discussionmentioning

confidence: 99%

Section: Decannulation Protocolsmentioning

confidence: 99%

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Decannulation following tracheostomy in children: A systematic review of decannulation protocols

Verma

Mocanu

Shi

et al. 2021

Pediatric Pulmonology

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“…Institutions may use protocols including progressive tube downsizing, inpatient and/or outpatient capping trials, capped and uncapped polysomnography, and airway evaluations. There are a few small studies showing the value of pre‐ or postdecannulation polysomnography and airway evaluation by laryngoscopy and bronchoscopy in predicting successful decannulation 19–22 . Only three patients in the failure group of this study underwent capped polysomnography; therefore, we were unable to assess the value of this intervention before decannulation.…”

Section: Discussionmentioning

confidence: 89%

“…There are a few small studies showing the value of pre-or postdecannulation polysomnography and airway evaluation by laryngoscopy and bronchoscopy in predicting successful decannulation. [19][20][21][22] Only three patients in the failure group of this study underwent capped polysomnography; therefore, we were unable to assess the value of this intervention before decannulation.…”

Section: Discussionmentioning

confidence: 99%

Comparing decannulation failures and successes in pediatric tracheostomy: An 18‐year experience

Kolb

Halbert

Xiao

et al. 2021

Pediatric Pulmonology

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Objectives: There is a paucity of published literature identifying patients at higher risk of decannulation failure. The purpose of this study is to evaluate patient factors that may predict successful decannulation of pediatric tracheostomy patients and analyze factors contributing to tracheostomy decannulation failures.Methods: A retrospective chart review of tracheostomy outcomes was conducted at a pediatric referral hospital. Successful and failed decannulations were compared using the following patient variables: age at tracheostomy, sex, ethnicity, gestational age and weight, the primary indication for tracheostomy, comorbidities, age at decannulation attempt, polysomnography data, and status of airway before decannulation as assessed endoscopically by airway team.Results: Four hundred thirty-nine tracheostomies were performed over the 18-year period with 173 decannulation attempts. The overall rate of successful decannulation on the first attempt was 91.9% (159 of 173), with an eventual decannulation success rate of 97.1% (168 of 173). Compared with failed decannulations, the patients with successful decannulations had a shorter duration of tracheostomy and no medical comorbidities. Gestational age and weight approached, but did not achieve, statistical significance. After 25 months with a tracheostomy, approximately 50% of patients are decannulated with very few decannulations occurring after 75 months. The overall mortality rate in this cohort was 18.6% (78 of 420) with a tracheostomy-related mortality rate of 0.95% (4 of 420). Conclusions:The decannulation protocol at this institution is successful nearly 92% of the time. Fewer medical comorbidities, shorter duration of tracheostomy placement, and older gestational age may improve the likelihood of successful decannulation. Future studies are needed to determine the optimal timing and workup to evaluate patients for decannulation.

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The Role of Polysomnography in Tracheostomy Decannulation of Children with Bronchopulmonary Dysplasia

Cited by 2 publications

References 0 publications

Decannulation following tracheostomy in children: A systematic review of decannulation protocols

Decannulation following tracheostomy in children: A systematic review of decannulation protocols

Comparing decannulation failures and successes in pediatric tracheostomy: An 18‐year experience

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