Marco Pozzi1, Sara Galbiati1, Federica Locatelli1, Emilio Clementi1,2, Sandra Strazzer1. 1. Scientific Institute IRCCS Eugenio Medea, Bosisio Parini, Lecco, Italy. 2. Unit of Clinical Pharmacology, Department of Biomedical and Clinical Sciences L. Sacco, CNR Institute of Neuroscience, "Luigi Sacco" University Hospital, Università di Milano, Milan, Italy.
Abstract
OBJECTIVES: We assessed the performance of a tracheostomy decannulation protocol privileging safety over quickness, in pediatric patients undergoing rehabilitation from severe acquired brain injury. We analyzed factors associated with decannulation timing and possibility and examined cases of failure. HYPOTHESIS: A safe decannulation protocol should minimize failures. STUDY DESIGN: Retrospective observational study. PATIENT SELECTION: Patients aged 0-17 admitted to rehabilitation with tracheostomy in the last 15 years (n = 123). METHODOLOGY: We collected data on clinical and respiratory conditions at admittance, during the first rehabilitation stay and following follow-up controls. We described the sample and tested associations of several factors with the possibility to decannulate patients during either the first stay or follow-up. We described failures, defined as the cases in which tracheostomy tube had to be placed back immediately or after less than 1 month from removal. RESULTS: At admittance, 93.5% patients were dysphagic and 37.9% had respiratory complications (mainly accumulation of supraglottic secretions). At first discharge, dysphagia was reduced (62.1%) and respiratory complications increased (41.1%). Tracheostomy was removed during the first stay in 55.3% patients, during follow-up in 13%, without failures among the 80 patients who followed the protocol. Four decannulations performed against protocol recommendations resulted in three failures. Decannulation was mainly prevented by the persistence of respiratory complications and dysphagia that constituted a relevant risk of aspiration and suffocation; decannulation was mainly postponed because of respiratory complications and breath-holding spells in very young children. CONCLUSIONS: By applying a decannulation protocol that privileges safety over quickness, we encountered no failure. Respiratory complications and dysphagia that lead to supraglottic stagnation, and breath-holding spells, are key elements to consider before performing decannulation in pediatric patients.
OBJECTIVES: We assessed the performance of a tracheostomy decannulation protocol privileging safety over quickness, in pediatric patients undergoing rehabilitation from severe acquired brain injury. We analyzed factors associated with decannulation timing and possibility and examined cases of failure. HYPOTHESIS: A safe decannulation protocol should minimize failures. STUDY DESIGN: Retrospective observational study. PATIENT SELECTION: Patients aged 0-17 admitted to rehabilitation with tracheostomy in the last 15 years (n = 123). METHODOLOGY: We collected data on clinical and respiratory conditions at admittance, during the first rehabilitation stay and following follow-up controls. We described the sample and tested associations of several factors with the possibility to decannulate patients during either the first stay or follow-up. We described failures, defined as the cases in which tracheostomy tube had to be placed back immediately or after less than 1 month from removal. RESULTS: At admittance, 93.5% patients were dysphagic and 37.9% had respiratory complications (mainly accumulation of supraglottic secretions). At first discharge, dysphagia was reduced (62.1%) and respiratory complications increased (41.1%). Tracheostomy was removed during the first stay in 55.3% patients, during follow-up in 13%, without failures among the 80 patients who followed the protocol. Four decannulations performed against protocol recommendations resulted in three failures. Decannulation was mainly prevented by the persistence of respiratory complications and dysphagia that constituted a relevant risk of aspiration and suffocation; decannulation was mainly postponed because of respiratory complications and breath-holding spells in very young children. CONCLUSIONS: By applying a decannulation protocol that privileges safety over quickness, we encountered no failure. Respiratory complications and dysphagia that lead to supraglottic stagnation, and breath-holding spells, are key elements to consider before performing decannulation in pediatric patients.
Authors: Amanda K Morrow; David E Tunkel; Joseph M Collaco; Sharon A McGrath-Morrow; Janet C Lam; Jennifer A Accardo; Suzanne V Rybczynski Journal: Pediatr Pulmonol Date: 2018-12-11