Related Experiment Video
Updated: Sep 13, 2025
A Novel Rescue Technique for Difficult Intubation and Difficult Ventilation
Published on: January 17, 2011
Paediatric tracheostomy: Can we predict time to decannulation?
David Brinkman1, Roisin Mullan1, Rania Mehanna1
1Children's Health Ireland at Crumlin, Ireland.
Insights
Feeding route significantly impacts paediatric tracheostomy decannulation success. Younger age at insertion and tube feeding predict longer decannulation times, while older age predicts shorter times.
Area of Science:
- Pediatric Otolaryngology
- Respiratory Medicine
- Pediatric Surgery
Background:
- Pediatric tracheostomy imposes a significant care burden on healthcare systems and families.
- Successful decannulation and its timing are crucial considerations during tracheostomy insertion.
- Comprehensive evidence on factors influencing pediatric tracheostomy decannulation is limited.
Purpose of the Study:
- To identify key predictive criteria for successful pediatric tracheostomy decannulation.
- To analyze factors affecting the time required for decannulation in pediatric patients.
Main Methods:
- Retrospective review of 153 pediatric tracheostomy patients over 20 years.
- Analysis of factors including age, feeding route, comorbidities, and ventilation status.
- Univariable, multivariable, and Cox regression analyses were performed.
Main Results:
- Feeding route was a significant predictor of decannulation success (multivariable analysis).
- Younger age at insertion (<6 weeks) and sole tube feeding predicted successful decannulation.
- Longer decannulation times were associated with sole tube feeding, younger age at insertion, and neurological comorbidities.
Conclusions:
- Feeding route is a significant predictor of pediatric tracheostomy decannulation success.
- Multiple factors influence the time to successful decannulation in pediatric patients.
- Findings can inform discussions with primary caregivers regarding decannulation outcomes.
Introduction:
Paediatric tracheostomy is associated with a significant burden of care on health systems and primary caregivers. Decannulation is regularly part of the discussion during insertion. Being fully aware of factors that affect successful decannulation and time to decannulation is important for consenting primary caregivers, but there is a paucity of comprehensive evidence.
Aim:
Our objective was to try and establish important predictive criteria.
Methods:
A retrospective review of all tracheostomy patients in a national tertiary paediatric referral centre over 20 years with data on factors drawn from existing literature and additional factors significant for paediatric otolaryngologists was performed. Univariable and multivariable analysis for decannulation success and cox regression analysis on time to decannulation was performed. We included all patients that were cared for at our facility and excluded only patients that had incomplete data available.
Results:
153 patients were included for analysis. Corrected age at insertion of less than 6 weeks and sole tube feeding were found to be significant predictors of successful decannulation on univariable analysis, with maintenance of significance of feeding route on multivariable analysis. There was no significant effect on decannulation success with presence of comorbidities, long term ventilation, gestation, emergency status, EXIT procedure or requirement for intervention pre-decannulation on univariable analysis. There was no significant difference in time to decannulation with sole upper airway obstruction or long-term ventilation, mixed oral and tube feeding route, cardiac, respiratory, or genetic comorbidities, or requirement for intervention pre-decannulation. Significantly shorter time to successful decannulation was seen with age at insertion of greater than 12 months, while a significantly longer time was seen with sole tube feeding route, age of less than six weeks at insertion, indication for insertion of a combination of upper airway obstruction and long-term ventilation, neurological co-morbidities and two or more comorbidities on Cox regression analysis.
Conclusion:
Our analysis demonstrated feeding route to be a significant predictor of decannulation success on multivariable analysis. We also demonstrated multiple predictors of time to decannulation. These findings should aid in the discussion around decannulation with primary caregivers.
Related Concept Videos
01:21Tracheostomy Decannulation
Description of the Procedure
Decannulation refers to the permanent removal of the tracheostomy tube, signaling the resolution of the condition that initially necessitated the tracheostomy. The process requires a well-coordinated interplay between...
01:16Tracheostomy Care I: Pre-procedural Steps
Required Equipment
The equipment necessary for tracheostomy care includes:
01:28Tracheostomy: Procedure and Tubes
Tracheostomy tubes can be made of semiflexible plastic (polyurethane or silicone), rigid plastic, or metal, and they come in...
01:26Tracheostomy Suctioning I: Pre-Procedural Steps
Equipment Required
First, gather all necessary equipment: a sterile suction catheter, a sterile disposable container, sterile gloves, a towel or...
01:23Oxygen Delivering System III: Tracheostomy and T-piece
Tracheostomy
A tracheostomy is a surgically created opening (stoma) in the anterior part of the trachea. It is used to establish a patient airway, bypass an upper airway obstruction, simplify the removal of secretions, permit long-term...
01:25Tracheostomy Care II: Procedure
Step 1: Perform hand hygiene, and put on personal protective equipment: gown, gloves, mask...