Affiliations: [a] Department of Pediatric Otolaryngology, Nationwide Children’s Hospital, Columbus, OH, USA | [b] Department of Otolaryngology-Head and Neck Surgery, Wexner Medical Center at Ohio State University, Columbus, OH, USA | [c] Department of Surgery, Nationwide Children’s Hospital, Columbus, OH, USA | [d] Center for Surgical Outcomes Research and the Center for Innovation in Pediatric Practice, The Research Institute at Nationwide Children’s Hospital, Columbus, OH, USA | [e] Department of Pediatric Pulmonology and Sleep Medicine, Nationwide Children’s Hospital, Columbus, OH, USA
Abstract: PURPOSE: To determine if medical or functional factors influence the ability of a pediatric patient with a tracheostomy to tolerate decannulation. METHODS: Retrospective evaluation of patients at a tertiary Children’s Hospital undergoing evaluation with capped tracheostomy polysomnogram (cPSG) for possible tracheostomy decannulation. Charts were reviewed for demographic information, functional status, cPSG characteristics, and success or failure of decannulation. Statistical analysis was performed to determine which patient factors were predictive of successful decannulation. RESULTS: A total of 139 sleep studies were analyzed in 104 unique children followed for at least 1 year after a cPSG was performed to determine readiness for decannulation. At 1 year after most recent PSG, 79.8% of children were decannulated. There was no significant association between any single comorbid condition and the ability to decannulate. There was no association between individual or total functional status score and successful decannulation. Patients with at least 3 comorbid conditions investigated and a total functional score less than 7 were less likely to be decannulated successfully than other patients (71% vs. 93%, p= 0.04). CONCLUSION: Functional status and comorbid conditions do not independently predict successful decannulation. Regular multi-disciplinary team reevaluation is indicated in patients with lower functional status, as removal of tracheostomy tube may be successfully accomplished.
