Investigation of the Paediatric Tracheostomy Decannulation: Factors Affecting Outcome

Introduction: Evidence for factors determining paediatric tracheostomy decannulation vary extensively; therefore, this prospective observational study aimed to investigate these factors.   Materials and Methods: In total, 67 consecutive paediatric patients (<12 years old) who referred to the Department of Otolaryngology, (Postgraduate Institute Medical Education and Research),(Chandigarh), India, for decannulation were included and evaluated for contributing factors in this study. Parental counselling was performed, and informed consents were obtained from them. The patients underwent detailed work up including X-rays of airway/soft tissue neck (STN) and endoscopic assessment under anaesthesia for evaluating airway patency. Decannulations were attempted post assessment and followed up one month to classify decannulation as success or failure regarding the removal of the tracheostomy tube.   Results: Totally, 61 patients out of 67 cases were successfully decannulated, whereas six children failed the decannulation. Moreover, the duration of tracheostomy (Pearson’s Chi-square 35.330, P=0.013), indication of tracheostomy (Pearson’s Chi-square 21.211, P=0.000), STN X-Ray (Chi-square 43.249, P=0.000), and bronchoscopic findings (Chi-square 67.000, P=0.000) were significantly associated with the outcome of decannulation. However, decannulation outcome had no significant correlation with various factors, such as the duration of intubation preceding tracheostomy, duration of ventilation, tracheal swabs, and antibiotic therapy.   Conclusion: The STN X-ray is an independent predictor, and it is recommended for paediatric tracheostomy decannulation. Moreover, bronchoscopic assessment should be performed in children having doubtful infra-stomal airway. Duration of tracheostomy significantly affects decannulation outcome. However, intubation duration preceding tracheostomy and duration of assistive ventilation have no direct effects on the outcome of decannulation. In children, gradual decannulation should be preferred and one month follow up is adequate for deciding decannulation outcome.