Investigation of the Paediatric Tracheostomy Decannulation: Factors Affecting Outcome

Document Type: Original

Authors

1 Department of Otolaryngology and Head and Neck Surgery, Postgraduate Institute of Medical Education and Research, Chandigarh, India.

2 Department of Otolaryngology and Head and Neck Surgery, Postgraduate Institute of Medical Education and Research, Chandigarh, India.

3 Department of Anaesthesia, Postgraduate Institute of Medical Education and Research, Chandigarh, India.

4 Department of Paediatrics, Postgraduate Institute of Medical Education and Research, Chandigarh, India.

Abstract

Introduction:
Evidence for factors determining paediatric tracheostomy decannulation vary extensively; therefore, this prospective observational study aimed to investigate these factors.
 
Materials and Methods:
In total, 67 consecutive paediatric patients (  
Results:
Totally, 61 patients out of 67 cases were successfully decannulated, whereas six children failed the decannulation. Moreover, the duration of tracheostomy (Pearson’s Chi-square 35.330, P=0.013), indication of tracheostomy (Pearson’s Chi-square 21.211, P=0.000), STN X-Ray (Chi-square 43.249, P=0.000), and bronchoscopic findings (Chi-square 67.000, P=0.000) were significantly associated with the outcome of decannulation. However, decannulation outcome had no significant correlation with various factors, such as the duration of intubation preceding tracheostomy, duration of ventilation, tracheal swabs, and antibiotic therapy.
 
Conclusion:
The STN X-ray is an independent predictor, and it is recommended for paediatric tracheostomy decannulation. Moreover, bronchoscopic assessment should be performed in children having doubtful infra-stomal airway. Duration of tracheostomy significantly affects decannulation outcome. However, intubation duration preceding tracheostomy and duration of assistive ventilation have no direct effects on the outcome of decannulation. In children, gradual decannulation should be preferred and one month follow up is adequate for deciding decannulation outcome.

Keywords