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The Great Ormond Street protocol for ward decannulation of children with tracheostomy: increasing safety and
A Waddell1, R Appleford, C Dunning
1Department of Otolaryngology, Great Ormond Street Hospital for Children NHS Trust, London, UK.
Insights
This study suggests a safe tracheostomy decannulation protocol can reduce hospital stays to five days. Early signs of distress like restlessness may indicate potential decannulation failure in children.
Area of Science:
- Pediatric Otolaryngology
- Respiratory Medicine
- Pediatric Critical Care
Background:
- Tracheostomy is a common procedure for pediatric airway management.
- Ward decannulation is the final step for most children with tracheostomies.
- Current protocols involve a prolonged hospital stay post-decannulation.
Purpose of the Study:
- To determine the minimum safe inpatient stay duration for pediatric tracheostomy decannulation.
- To identify factors predicting successful decannulation versus failure.
Main Methods:
- Retrospective review of 84 pediatric patients undergoing decannulation between 1991 and 1996.
- Analysis of initial pathology, tracheostomy duration, and decannulation outcomes.
- Correlation of nursing observations with decannulation success or failure.
Main Results:
- No correlation found between initial pathology or tracheostomy duration and decannulation success.
- Restlessness, anxiety, and recession were more frequent in children who failed decannulation.
- All decannulation failures occurred within 48 hours of a 24-hour tracheostomy occlusion trial.
Conclusions:
- A shorter inpatient stay, potentially five days, is safe for pediatric tracheostomy decannulation.
- Nursing observations of specific symptoms can help identify children at higher risk of decannulation failure.
- This supports revising current decannulation protocols to optimize resource utilization and patient discharge.
Abstract:
Ward decannulation is the eventual endpoint for the majority of the 40 children managed by tracheostomy at Great Ormond Street Hospital each year. Our previous protocol dictated a 10 day stay in hospital for the 25 children decannulated annually. The aim of this retrospective study was to determine the minimum safe duration for this inpatient stay. In addition, we hoped to identify any factors which might distinguish potentially successful candidates from those likely to fail decannulation. Of 104 patients decannulated between January 1991 and January 1996, complete nursing and medical records were retrieved for 84 children. These notes were retrospectively reviewed and in this group of patients there were 101 attempted decannulations. Information about the initial pathology, interim course and details of the decannulation were collected. Summary statistics were generated. There was no relation between initial pathology or duration of tracheostomy and eventual success or failure of decannulation. Observations by the nursing staff of restlessness, anxiety and recession appeared more frequently in children who eventually failed decannulation. All failures occurred within 48 h of the 24 h trial of tracheostomy blocking. Our results suggest that a safe decannulation protocol can allow discharge after day five.