Tidal Flow Measurement in the Decision to Decannulate the Pediatric Patient

Gb, Mallory; Js, Reilly; Ek, Motoyama; Mutich, Rebecca L.; Ma, Kenna; Se, Stool

doi:10.1177/000348948509400507

Cited by 20 publications

(14 citation statements)

References 4 publications

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“…Agreement exists among authors that prior to decannulation an endoscopic airway evaluation should be performed to assess airway patency and when combined with a favorable PSG can increase the chances of a successful decannulation . Our study confirms these recommendations as 28 capped PSGs were unfavorable due to airway obstruction mostly from adenotonsillar hypertrophy and suprastomal granulomas.…”

Section: Discussionsupporting

confidence: 80%

Polysomnography Provides Useful Clinical Information in the Liberation from Respiratory Technology: A Retrospective Review

Bashir

Henningfeld

Thompson

et al. 2018

Pediatric Pulmonology

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Background The prevalence of respiratory‐technology dependent children is increasing although for most children the goal is liberation from technology. Liberation from home mechanical ventilation (HMV) and decannulation strategies vary due to the lack of clinical practice standards. The primary objective of this study was to describe our practice utilizing a polysomnography (PSG) in the liberation from respiratory‐technology process. Methods Retrospective study of tracheostomized children with and without HMV who underwent an evaluation for decannulation between January 2006 and June 2016. Patient demographics, indication for tracheostomy, indication for PSG, PSG results and interventions performed after the PSG were collected. Results We identified 153 decannulation attempts in 148 children. Ninety‐nine children had a tracheostomy only and 49 children had a tracheostomy with HMV. There were 190 PSGs performed. Almost two‐thirds of the children (N = 92) had at least one PSG, 37 children (25%) had two and 19 children (13%) had more than 2 PSGs. Children with tracheostomy and HMV had more PSGs compared to children with tracheostomy only. PSGs were performed at four points: (1) prior to tracheostomy placement (N = 23); (2) to titrate HMV (N = 19); (3) off‐HMV support (N = 43); and with a capped tracheostomy (N = 101). Most of the off‐HMV PSGs (N = 39) were favorable for discontinuing HMV. About two‐thirds of the capped PSGs (N = 73) were favorable for decannulation; of the unfavorable capped PSGs (N = 28), thirteen required airway surgeries following the unfavorable PSG. Conclusion : Overnight PSG provides useful information to the liberation process, particularly when determining readiness for discontinuing HMV and decannulation.

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Section: Discussionsupporting

confidence: 80%

Polysomnography Provides Useful Clinical Information in the Liberation from Respiratory Technology: A Retrospective Review

Bashir

Henningfeld

Thompson

et al. 2018

Pediatric Pulmonology

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“…1 Only six out of 143 children in our series (four per cent) underwent tracheostomy for upper airways infection, in contrast to 12.5 per cent in Mallory's 1985 report 12 and 43 per cent in Gaudet's 1978 study. 13 In addition to the changing indications, there has also been a shift in the average age of children undergoing tracheostomy, away from the older child towards young infants.…”

Section: 69-11mentioning

confidence: 64%

Paediatric tracheostomy: Sheffield Experience 1979–1999

2002

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We have reviewed our experience of tracheostomy in children over the past 20 years at Sheffield Children's Hospital. One hundred and forty-eight tracheostomies were performed in 143 children aged one day to 13 years old (average 27 months). Sixty-five per cent of patients were < one year old. The indications for tracheostomy were upper airways' obstruction in 72 per cent, and assisted ventilation/ bronchopulmonary toilet in 28 per cent. The commonest single reason was acquired subglottic stenosis (SGS) in infants, accounting for 25 per cent of tracheostomies (36/143). The complication rate of tracheostomy was 46 per cent, most commonly granulation tissue formation. There were four deaths directly due to the tracheostomy: two accidental decannulations and two obstructions. Eighty-nine children were decannulated under our care. The average time until decannulation was 25 months.

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“…This ratio was initially described as an index of respiratory drive, but it has also been found to be a reliable clinical index of upper airway obstruction. [23][24][25] In all but three patients the t i /t tot was within the normal range, thus discounting upper airway obstruction as a common condition among infants with SCD.…”

Section: Discussionmentioning

confidence: 74%