Ventilator weaning and tracheostomy decannulation in children: More than one way

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.

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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

Bashir

Henningfeld

Thompson

et al. 2018

“…Approaches and strategies to decannulation vary among providers and institutions . Most centers typically begin this process once the initial indication for tracheostomy has resolved, the patient has been liberated from mechanical ventilation, requires minimal to no supplemental oxygen and has infrequent respiratory infections .…”

Section: Introductionmentioning

confidence: 99%

“…11,12 Approaches and strategies to decannulation vary among providers and institutions. 13 Most centers typically begin this process once the initial indication for tracheostomy has resolved, the patient has been liberated from mechanical ventilation, requires minimal to no supplemental oxygen and has infrequent respiratory infections. 14,15 Current consensus among otolaryngologists and pulmonologists suggests that an airway endoscopy be performed before tracheostomy decannulation to assess vocal cord motion, evaluate for suprastomal collapse, and ensure airway patency.…”

Section: Introductionmentioning

confidence: 99%

The role of polysomnography in tracheostomy decannulation of children with bronchopulmonary dysplasia

Quinlan

Piccione

Kim

et al. 2019

Background Patients with bronchopulmonary dysplasia (BPD) may require tracheostomy for long‐term mechanical ventilation. Polysomnography (PSG) may predict successful decannulation in children, however it is unclear how this success compares with children without a PSG. To better evaluate this role, we compared decannulation outcomes between tracheostomy‐dependent children with BPD who underwent PSG before decannulation to those who did not. Methods This is a retrospective cohort study between 1 January 2007 and 1 June 2017 of tracheostomy‐dependent children with BPD who were clinically considered for decannulation. Patient demographics, PSG results, and medical comorbidities were abstracted from medical records and compared between groups. Decannulation outcomes were compared between children with BPD who underwent PSG before decannulation and those who did not. Results One hundred twenty‐five patients with BPD were considered for tracheostomy decannulation. Forty‐six (37%) had a pre‐decannulation PSG while 79 (63%) did not. Nineteen (41%) patients did not undergo decannulation within 6 months of the PSG. One (3%) patient with pre‐decannulation PSG failed decannulation. Four (5%) patients without pre‐decannulation PSG failed decannulation. Nineteen patients with PSG and no decannulation had significantly higher obstructive apnea‐hypopnea index (OAHI) (13.62 vs 2.68 events per hour, P = 0.004), higher end‐tidal CO 2 max (52.84 vs 48.03 mm Hg, P = 0.035), and were older at PSG (median age, 6.04 vs 4.04 years, P = 0.008). Conclusions While successful decannulation can be achieved without a PSG in some patients, PSG is a valuable tool to identify BPD patients undergoing clinical evaluation for decannulation who would benefit from treatment of OSA before decannulation.

Performance of a tracheostomy removal protocol for pediatric patients in rehabilitation after acquired brain injury: Factors associated with timing and possibility of decannulation

Pozzi

Galbiati

Locatelli

et al. 2017