Inpatient observation for elective decannulation of pediatric patients with tracheostomy

The incidence and timing patterns of decannulation failure in children are unknown. There is substantial variability in the duration of inpatient hospitalization for patients undergoing decannulation, which represents an opportunity for improved resource use.

To determine the incidence and timing patterns of elective decannulation failure in the pediatric population and to determine an appropriate interval of inpatient observation following decannulation that optimizes both patient safety and resource use.

Retrospective review of medical records of consecutive patients 18 years or younger hospitalized for elective, inpatient decannulation between January 1, 2012, and October 31, 2013, at a quaternary care pediatric hospital.

Duration of decannulation hospitalization, failure of elective decannulation (decision not to decannulate or reinsertion of tracheostomy tube after decannulation), time interval from decannulation to failure.

Forty-six patients completed 50 elective decannulation hospitalizations during the study period. The median duration of hospitalization for decannulation was 3.0 days. The hospitalization-specific failure rate was 16% (8 of 50), and the overall failure rate was 9% (4 of 46). Four patients were not able to tolerate capping of the tracheostomy tube and were discharged with their original tracheostomy tubes in place. Three of these patients were decannulated at a later hospitalization. In 4 patients, decannulation failed and they had to have their tracheostomy tubes replaced prior to discharge. Patients who did not tolerate decannulation were younger (mean [SD] age, 45.7 [17.0] months) than patients whose decannulation was successful (68.2 [48.0] months). All patients with unsuccessful decannulation attempts were symptomatic during capping. The longest interval from decannulation to tracheostomy reinsertion was 11 hours.

Elective decannulation failure occurred in 9% of this population and may be more common in younger patients and those with a diagnosis of vocal fold paralysis. Patients who are symptomatic during predecannulation capping are at high risk for decannulation failure. Inpatient observation for a 24-hour asymptomatic interval after decannulation may be sufficient because late failures were not observed in this sample.