Hostname: page-component-586b7cd67f-dsjbd Total loading time: 0 Render date: 2024-11-25T12:52:40.771Z Has data issue: false hasContentIssue false
  • English
  • Français

Determinants of successful tracheostomy decannulation in children: a multicentric cohort study

Published online by Cambridge University Press:  08 January 2020

C Schweiger ,
D Manica ,
J F Lubianca Neto ,
L Sekine ,
R Krumenauer ,
J A Caixeta ,
R Maunsell  and
M Gomes Avelino
C Schweiger*
Affiliation:
Division of Otorhinolaryngology – Head and Neck Surgery, Hospital de Clínicas de Porto Alegre, Brazil Programa de Pós-Graduação em Saúde da Criança e do Adolescente (‘PPGSCA’), Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
D Manica
Affiliation:
Division of Otorhinolaryngology – Head and Neck Surgery, Hospital de Clínicas de Porto Alegre, Brazil
J F Lubianca Neto
Affiliation:
Division of Otorhinolaryngology, Hospital da Criança Santo Antônio, Porto Alegre, Brazil Department of Otorhinolaryngology, Universidade Federal de Ciências da Saúde de Porto Alegre, Brazil
L Sekine
Affiliation:
Epidemiologist, Hospital de Clínicas de Porto Alegre, Brazil
R Krumenauer
Affiliation:
Division of Otorhinolaryngology, Hospital da Criança Santo Antônio, Porto Alegre, Brazil
J A Caixeta
Affiliation:
Division of Otorhinolaryngology, Universidade Federal de Goiás, Goiânia, Brazil
R Maunsell
Affiliation:
Division of Otorhinolaryngology, Universidade Estadual de Campinas (‘UNICAMP’), Campinas, Brazil
M Gomes Avelino
Affiliation:
Division of Otorhinolaryngology, Universidade Federal de Goiás, Goiânia, Brazil
*
Author for correspondence: Dr Cláudia Schweiger, Division of Otorhinolaryngology – Head and Neck Surgery, Hospital de Clinicas de Porto Alegre, Ramiro Barcelos, 2350 – Zona 19, Porto Alegre, ZIP code: 90035-003, Brazil E-mail: [email protected]
Get access Rights & Permissions [Opens in a new window]

Abstract

Background

Determining prognostic factors for the probability of tracheostomy decannulation is key to an adequate therapeutic plan.

Methods

A retrospective cohort study of 160 paediatric patients undergoing tracheostomy was conducted. Associations between different parameters and eventual tracheostomy decannulation were assessed.

Results

Mean follow-up duration was 27.8 months (interquartile range = 25.5–30.2 months). Median age at tracheostomy was 6.96 months (interquartile range = 3.37–29.42 months), with median tracheostomy maintenance of 14.5 months (interquartile range = 3.7–21.5 months). The overall tracheostomy decannulation rate was 22.5 per cent. Factors associated with a higher probability of tracheostomy decannulation included age at tracheostomy (hazard ratio = 1.11, 95 per cent confidence interval = 1.03–1.18) and post-intubation laryngitis as an indication for tracheostomy (hazard ratio = 2.25, 95 per cent confidence interval = 1.09–4.62). Neurological (hazard ratio = 0.30, 95 per cent confidence interval = 0.12–0.80) and pulmonary (hazard ratio = 0.41, 95 per cent confidence interval = 0.18–0.91) co-morbidities were negatively associated with tracheostomy decannulation. The probability of tracheostomy decannulation decreased significantly with increasing numbers of co-morbidities (p < 0.001).

Conclusion

Age, post-intubation laryngitis, and number and type of co-morbidities influence tracheostomy decannulation rate in the paediatric population.

Keywords

TracheostomyInfantChildProspective StudiesAirway Management
Type
Main Articles
Information
The Journal of Laryngology & Otology , Volume 134 , Issue 1 , January 2020 , pp. 63 - 67
Copyright
Copyright © JLO (1984) Limited, 2020

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

Footnotes

Dr C Schweiger takes responsibility for the integrity of the content of the paper

References

Ogilvie, LN, Kozak, JK, Chiu, S, Adderley, RJ, Kozak, FK. Changes in pediatric tracheostomy 1982–2011: a Canadian tertiary children's hospital review. J Pediatr Surg 2014;49:1549–53Google ScholarPubMed
Gergin, O, Adil, EA, Kawai, K, Watters, K, Moritz, E, Rahbar, R. Indications of pediatric tracheostomy over the last 30 years: has anything changed? Int J Pediatr Otorhinolaryngol 2016;87:144–710.1016/j.ijporl.2016.06.018CrossRefGoogle ScholarPubMed
Line, WS Jr, Hawkins, DB, Kahlstrom, EJ, MacLaughlin, EF, Ensley, JL. Tracheotomy in infants and young children: the changing perspective 1970–1985. Laryngoscope 1986;96:510–1510.1288/00005537-198605000-00008CrossRefGoogle ScholarPubMed
Beaton, F, Baird, TA, Clement, WA, Kubba, H. Tracheostomy decannulation at the Royal Hospital for Sick Children in Glasgow: predictors of success and failure. Int J Pediatr Otorhinolaryngol 2016;90:204–910.1016/j.ijporl.2016.07.013CrossRefGoogle ScholarPubMed
Knollman, PD, Baroody, FM. Pediatric tracheotomy decannulation: a protocol for success. Curr Opin Otolaryngol Head Neck Surg 2015;23:485–9010.1097/MOO.0000000000000204CrossRefGoogle Scholar
Leung, R, Berkowitz, RG. Decannulation and outcome following pediatric tracheostomy. Ann Otol Rhinol Laryngol 2005;114:743–8Google ScholarPubMed
Prickett, KK, Sobol, SE. Inpatient observation for elective decannulation of pediatric patients with tracheostomy. JAMA Otolaryngol Head Neck Surg 2015;141:120–510.1001/jamaoto.2014.3013CrossRefGoogle ScholarPubMed
Takahashi, N, Takano, K, Mitsuzawa, H, Kurose, M, Himi, T. Factors associated with successful decannulation in pediatric tracheostomy patients. Acta Otolaryngol 2017;137:1104–910.1080/00016489.2017.1326064CrossRefGoogle ScholarPubMed
Wirtz, N, Tibesar, RJ, Lander, T, Sidman, J. A pediatric decannulation protocol: outcomes of a 10-year experience. Otolaryngol Head Neck Surg 2016;154:731–410.1177/0194599816628522CrossRefGoogle ScholarPubMed
Maunsell, R, Avelino, M, Caixeta Alves, J, Semenzati, G, Lubianca Neto, JF, Krumenauer, R et al. Revealing the needs of children with tracheostomies. Eur Ann Otorhinolaryngol Head Neck Dis 2018;135:S93–710.1016/j.anorl.2018.07.007CrossRefGoogle ScholarPubMed
Schweiger, C, Manica, D, Becker, CF, Abreu, LSP, Manzini, M, Sekine, L et al. Tracheostomy in children: a ten-year experience from a tertiary center in southern Brazil. Braz J Otorhinolaryngol 2017;83:627–3210.1016/j.bjorl.2016.08.002CrossRefGoogle ScholarPubMed
Gurbani, N, Promyothin, U, Rutter, M, Fenchel, MC, Szczesniak, RD, Simakajornboon, N. Using polysomnography and airway evaluation to predict successful decannulation in children. Otolaryngol Head Neck Surg 2015;153:649–5510.1177/0194599815591531CrossRefGoogle ScholarPubMed
Lee, J, Soma, MA, Teng, AY, Thambipillay, G, Waters, KA, Cheng, AT. The role of polysomnography in tracheostomy decannulation of the paediatric patient. Int J Pediatr Otorhinolaryngol 2016;83:132–610.1016/j.ijporl.2016.01.034CrossRefGoogle ScholarPubMed
Robison, JG, Thottam, PJ, Greenberg, LL, Maguire, RC, Simons, JP, Mehta, DK. Role of polysomnography in the development of an algorithm for planning tracheostomy decannulation. Otolaryngol Head Neck Surg 2015;152:180–410.1177/0194599814557467CrossRefGoogle ScholarPubMed