International Pediatric Otolaryngology Group (IPOG) management recommendations: Pediatric tracheostomy decannulation
Section snippets
Objectives
To provide recommendations on the assessment of decannulation readiness and stepwise approach to tracheostomy decannulation in children with tracheostomies.
Target population
All children with tracheostomy tubes who are being assessed for decannulation.
Intended users
- 1
These recommendations are targeted for:
- 2
Otolaryngologists and pulmonologists who manage decannulation of patients with tracheostomies.
Allied clinicians, including pediatricians, who collaborate in the management of these patients.
Methods
Recommendations are based on review of the literature and expert opinion of the members of the International Pediatric Otolaryngology Group (IPOG). The mission of IPOG is to develop expertise-based recommendations for the management of pediatric otolaryngologic disorders with the goal of improving patient-centered care, quality and safety.
An online survey was formulated by the three of the authors (CKH, AdA, MJR). The survey was distributed to members of the group by email and responses were
Recommendations and justification
Twenty-six members of the IPOG completed the survey. The recommendations are outlined in the following sections.
Section 1: Criteria for decannulation readiness
Section 2: Steps to decannulation
Section 3: Decannulation protocol
Section 4: Decannulation failures
Conclusion
Readiness for decannulation should be determined based upon airway endoscopy findings, a patient's oxygen requirement and secretion management. Decannulation should proceed in a stepwise fashion with airway endoscopy and a capping trial always being performed prior to decannulation. There is significant variation in the duration of capping recommended prior to decannulation. Decannulation should take place in the inpatient setting with observation of a minimum of 24–48 h. Decannulation failure
Funding source
No funding was secured for this study.
Financial disclosure
The authors have no relevant financial relationships to disclose.
Declaration of competing interest
The authors have no relevant conflicts of interest to disclose.
Acknowledgements
Drs. Aimee Kennedy, Catherine Hart, Alessandro de Alarcon and Michael Rutter were the lead authors and Dr. Reza Rahbar provided primary consulting and guidance regarding the design of the recommendations. All remaining authors are listed in alphabetical order. The authorship list follows the agreement of the members of the IPOG. All authors have contributed to the conception and design of the work, drafting and revising the recommendations for important intellectual content, final approval of
References (18)
- et al.
First clinical consensus and national recommendations on tracheostomized children of the Brazilian academy of pediatric otorhinolaryngology (ABOPe) and Brazilian society of pediatrics (SBP)
Braz J Otorhinolaryngol
(2017 Sep-Oct) - et al.
Pediatric tracheostomy decannulation: when can decannulation Be performed safely outside of the intensive care setting? A 10 Year review from a single tertiary Otolaryngology service
Int. J. Pediatr. Otorhinolaryngol.
(2020 Jun) - et al.
Tracheostomy decannulation at the royal hospital for sick children in glasgow: predictors of success and failure
Int. J. Pediatr. Otorhinolaryngol.
(2016 Nov) - et al.
The Great Ormond Street Protocol for ward decannulation of children with tracheostomy: increasing safety and decreasing cost
Int. J. Pediatr. Otorhinolaryngol.
(1997) - et al.
Clinical consensus statement: tracheostomy care
Otolaryngol. Head Neck Surg.
(2013 Jan) - et al.
Use of polysomnography to assess safe decannulation in children
Pediatr. Pulmonol.
(2016 Aug) - et al.
Using polysomnography and airway evaluation to predict successful decannulation in children
Otolaryngol. Head Neck Surg.
(2015 Oct) - et al.
Role of polysomnography in the development of an algorithm for planning tracheostomy decannulation
Otolaryngol. Head Neck Surg.
(2015 Jan) - et al.
Polysomnography in the evaluation of readiness for decannulation in children
Arch. Otolaryngol. Head Neck Surg.
(1996 Jul)
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