Factors Associated With Accidental Decannulation in Tracheostomized Children

Area of Science:

• Pediatric critical care medicine
• Otolaryngology
• Respiratory therapy

Background:

• Tracheostomy is common in pediatric ICU patients but carries risks.
• Accidental decannulation (AD) is a frequent and potentially fatal complication.
• Identifying factors associated with AD is crucial for patient safety.

Purpose of the Study:

• To determine factors associated with accidental decannulation in pediatric tracheostomy patients.
• To identify risk factors for AD in children requiring prolonged mechanical ventilation.
• To inform strategies for preventing AD in this vulnerable population.

Main Methods:

• A case-control study was conducted between 2013-2018.
• Cases were pediatric patients experiencing accidental decannulation; controls were those without AD.
• A 1:2 allocation ratio was used to match cases with controls from the same hospital population.

Main Results:

• Accidental decannulation occurred in 41 out of 140 hospitalized pediatric patients.
• The risk of AD was significantly higher in children who could reach the midline while sitting (OR 9.5).
• Smaller tracheostomy tube inner diameter (≤ 4.0 mm) (OR 5.18) and lower nurse-to-patient ratios (OR 4.48) were also associated with increased AD risk.

Conclusions:

• Key risk factors for accidental decannulation in pediatric tracheostomy patients include sitting ability, smaller tube size, and reduced nursing supervision.
• These findings highlight the need for enhanced monitoring and tailored interventions.
• Preventive strategies should address patient positioning, tracheostomy tube selection, and staffing levels.