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Accidental Tracheostomy Decannulations in Children-A Prospective Cohort Study of Inpatients

Erin M Wynings1, Nathaniel Breslin1, Rebecca L Brooks2

  • 1Department of Otolaryngology - Head & Neck Surgery, University of Texas Southwestern Medical Center, Dallas, Texas, USA.

The Laryngoscope
|June 17, 2022
PubMed

Insights

Accidental decannulations (AD) in pediatric patients occur at nearly 5 events per 1000 tracheostomy-days, often causing minor harm. Quality initiatives can reduce these tracheostomy complications.

Area of Science:

  • Pediatric critical care medicine
  • Otolaryngology
  • Patient safety research

Background:

  • Tracheostomy is a common procedure in pediatric care.
  • Accidental decannulation (AD) is a known complication.
  • Understanding AD incidence and risk factors is crucial for patient safety.

Purpose of the Study:

  • To determine the incidence of accidental decannulations (AD) in pediatric inpatients.
  • To identify risk factors associated with AD events.
  • To evaluate the impact of safety initiatives on AD rates.

Main Methods:

  • A prospective cohort study was conducted.
  • Included pediatric patients (≤18 years) with tracheostomies.
  • Recorded AD events, patient harm, and contributing factors over a defined period.

Main Results:

  • 117 AD events occurred in 67 children; 33% experienced multiple events.
  • Common causes included patient movement (32%) and tracheostomy care (27%).
  • Mean incidence was 4.7 AD per 1000 tracheostomy-days; safety initiatives reduced this rate (p=0.04).

Conclusions:

  • Pediatric accidental decannulations occur frequently but typically result in minor harm.
  • Targeting patient movement, provider education, and tracheostomy care can reduce AD frequency.
  • Quality improvement initiatives demonstrate effectiveness in lowering AD rates.
Abstract

Keywords:
accidental decannulationpediatric tracheostomytracheostomy complications

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