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Investigation of the Paediatric Tracheostomy Decannulation: Factors Affecting Outcome
Neha Chauhan1, Satyawati Mohindra1, Sourabha K Patro1
1Department of Otolaryngology and Head and Neck Surgery, Postgraduate Institute of Medical Education and Research, Chandigarh, India.
Insights
Successful paediatric tracheostomy decannulation depends on factors like tracheostomy duration and airway imaging. Soft tissue neck X-rays are key predictors for removing the tracheostomy tube in children.
Area of Science:
- Otolaryngology
- Pediatric Surgery
- Respiratory Medicine
Background:
- Paediatric tracheostomy decannulation success factors are not well-established.
- Variability in evidence necessitates further investigation into decannulation determinants.
- This study addresses the need for clarity on factors influencing successful decannulation in children.
Purpose of the Study:
- To prospectively identify and evaluate factors affecting paediatric tracheostomy decannulation.
- To determine predictors of successful tracheostomy tube removal in children under 12.
- To establish guidelines for optimal decannulation strategies.
Main Methods:
- Prospective observational study of 67 paediatric patients (<12 years) undergoing decannulation assessment.
- Evaluation included airway patency assessment via soft tissue neck X-rays and bronchoscopy under anesthesia.
- Decannulation success was defined by successful tube removal and confirmed at one-month follow-up.
Main Results:
- 61 out of 67 patients (91%) were successfully decannulated.
- Tracheostomy duration, indication, soft tissue neck X-ray findings, and bronchoscopy results significantly correlated with decannulation success (P<0.05).
- Preceding intubation duration, ventilation duration, tracheal swabs, and antibiotic therapy did not significantly impact decannulation outcomes.
Conclusions:
- Soft tissue neck X-ray is a reliable independent predictor for paediatric tracheostomy decannulation.
- Bronchoscopic assessment is recommended for children with suspected infra-stomal airway issues.
- Gradual decannulation with a one-month follow-up is adequate for assessing success in paediatric patients.
Introduction:
Evidence for factors determining paediatric tracheostomy decannulation vary extensively; therefore, this prospective observational study aimed to investigate these factors.
Materials And Methods:
In total, 67 consecutive paediatric patients (<12 years old) who referred to the Department of Otolaryngology, (Postgraduate Institute Medical Education and Research),(Chandigarh), India, for decannulation were included and evaluated for contributing factors in this study. Parental counselling was performed, and informed consents were obtained from them. The patients underwent detailed work up including X-rays of airway/soft tissue neck (STN) and endoscopic assessment under anaesthesia for evaluating airway patency. Decannulations were attempted post assessment and followed up one month to classify decannulation as success or failure regarding the removal of the tracheostomy tube.
Results:
Totally, 61 patients out of 67 cases were successfully decannulated, whereas six children failed the decannulation. Moreover, the duration of tracheostomy (Pearson's Chi-square 35.330, P=0.013), indication of tracheostomy (Pearson's Chi-square 21.211, P=0.000), STN X-Ray (Chi-square 43.249, P=0.000), and bronchoscopic findings (Chi-square 67.000, P=0.000) were significantly associated with the outcome of decannulation. However, decannulation outcome had no significant correlation with various factors, such as the duration of intubation preceding tracheostomy, duration of ventilation, tracheal swabs, and antibiotic therapy.
Conclusion:
The STN X-ray is an independent predictor, and it is recommended for paediatric tracheostomy decannulation. Moreover, bronchoscopic assessment should be performed in children having doubtful infra-stomal airway. Duration of tracheostomy significantly affects decannulation outcome. However, intubation duration preceding tracheostomy and duration of assistive ventilation have no direct effects on the outcome of decannulation. In children, gradual decannulation should be preferred and one month follow up is adequate for deciding decannulation outcome.
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