International Pediatric Otolaryngology Group (IPOG) management recommendations: Pediatric tracheostomy decannulation

https://doi.org/10.1016/j.ijporl.2020.110565Get rights and content

Abstract

Objectives

To provide recommendations to otolaryngologists, pulmonologists, and allied clinicians for tracheostomy decannulation in pediatric patients.

Methods

An iterative questionnaire was used to establish expert recommendations by the members of the International Pediatric Otolaryngology Group.

Results

Twenty-six members completed the survey. Recommendations address patient criteria for decannulation readiness, airway evaluation prior to decannulation, decannulation protocol, and follow-up after both successful and failed decannulation.

Conclusion

Tracheostomy decannulation recommendations are aimed at improving patient-centered care, quality and safety in children with tracheostomies.

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

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