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Safety evaluation of a stepwise tracheostomy decannulation program in pediatric patients
Juma Obayashi1, Koji Fukumoto2, Masaya Yamoto2
1Department of Pediatric Surgery, Shizuoka Children's Hospital, 860 Urushiyama, Aoi-ku, Shizuoka, 420-8660, Japan. j2obayashi@marianna-u.ac.jp.
Pediatric Surgery International
|September 2, 2023
Summary
This study evaluated a stepwise tracheostomy decannulation program for pediatric patients. The program demonstrated safety, though failures can occur at any phase, necessitating careful monitoring during decannulation.
Area of Science:
- Pediatric Otolaryngology
- Respiratory Medicine
- Surgical Outcomes
Background:
- Tracheostomy decannulation failure can lead to severe patient outcomes.
- A structured approach is crucial for safe decannulation.
- Evaluating existing decannulation protocols is essential for improving patient care.
Purpose of the Study:
- To retrospectively evaluate the safety and efficacy of a stepwise tracheostomy decannulation program in pediatric patients.
- To identify potential failure points within a structured decannulation protocol.
Main Methods:
- A 12-year retrospective study of pediatric patients undergoing tracheostomy decannulation.
- Patients were selected based on airway patency and successful daytime cannula capping.
- A four-phase stepwise program included capping trials, tube removal, outpatient observation, and surgical fistula closure if needed.
Main Results:
- Eighty-six decannulation trials were conducted in 77 pediatric patients.
- The overall failure rate was 18.6% (16/86 trials), with failures occurring across all phases.
- Common reasons for failure included desaturation in early phases and dyspnea in later phases.
Conclusions:
- The stepwise tracheostomy decannulation program is a safe approach for pediatric patients.
- Failures can occur at any stage, highlighting the importance of continuous assessment and monitoring.
- The phased approach allows for early identification of complications and timely intervention.
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