Performance of a tracheostomy removal protocol for pediatric patients in rehabilitation after acquired brain injury: Factors associated with timing and possibility of decannulation

Marco Pozzi, Sara Galbiati, Federica Locatelli, Emilio Clementi, Sandra Strazzer

Research output: Contribution to journalArticle

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.

Original languageEnglish
Pages (from-to)1509-1517
Number of pages9
JournalPediatric Pulmonology
Volume52
Issue number11
DOIs
Publication statusPublished - Nov 1 2017

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Keywords

  • brain injury
  • dysphagia
  • evidence-based medicine and outcomes
  • pediatric
  • tracheostomy

ASJC Scopus subject areas

  • Pediatrics, Perinatology, and Child Health
  • Pulmonary and Respiratory Medicine

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