Pediatric tracheostomy decannulation: what's the evidence?

IF 1.9 4区 医学 Q2 OTORHINOLARYNGOLOGY
Tiffany Raynor, Joshua Bedwell
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引用次数: 0

Abstract

Purpose of review: Pediatric decannulation failure can be associated with large morbidity and mortality, yet there are no published evidence-based guidelines for pediatric tracheostomy decannulation. Tracheostomy is frequently performed in medically complex children in whom it can be difficult to predict when and how to safely decannulate.

Recent findings: Published studies regarding pediatric decannulation are limited to reviews and case series from single institutions, with varying populations, indications for tracheostomy, and institutional resources. This article will provide a review of published decannulation protocols over the past 10 years. Endoscopic airway evaluation is required to assess the patency of the airway and address any airway obstruction prior to decannulation. There is considerable variability in tracheostomy tube modification between published protocols, though the majority support a capping trial and downsizing of the tracheostomy tube to facilitate capping. Most protocols include overnight capping in a monitored setting prior to decannulation with observation ranging from 24 to 48 h after decannulation. There is debate regarding which patients should have capped polysomnography (PSG) prior to decannulation, as this exam is resource-intensive and may not be widely available. Persistent tracheocutaneous fistulae are common following decannulation. Excision of the fistula tract with healing by secondary intention has a lower reported operative time, overall complication rate, and postoperative length of stay.

Summary: Pediatric decannulation should occur in a stepwise process. The ideal decannulation protocol should be safe and expedient, without utilizing excessive healthcare resources. There may be variability in protocols based on patient population or institutional resources, but an explicitly described protocol within each institution is critical to consistent care and quality improvement over time. Further research is needed to identify selection criteria for who would most benefit from PSG prior to decannulation to guide allocation of this limited resource.

儿童气管造口拔管:有什么证据?
综述的目的:儿童拔管失败可能与高发病率和死亡率有关,但目前还没有发表儿童气管造口术拔管的循证指南。气管造口术经常在医学复杂的儿童中进行,他们很难预测何时以及如何安全地拔管。最近的发现:已发表的关于儿科拔管的研究仅限于单个机构的综述和病例系列,这些机构的人群、气管造口术的适应症和机构资源各不相同。本文将对过去10年中公布的拔管方案进行综述 年。插管前需要进行内窥镜气道评估,以评估气道的通畅性并解决任何气道阻塞。在已发表的方案中,气管造口管的修改存在相当大的差异,尽管大多数人支持进行加盖试验和缩小气管造口管以便于加盖。大多数方案包括在拔管前在监测环境中过夜加盖,观察范围为24至48 拔管后h。关于哪些患者应该在拔管前进行多导睡眠描记术(PSG),存在争议,因为这种检查是资源密集型的,可能不广泛。拔管后常见持续性气管皮瘘。经二次手术治愈的瘘管切除术报告的手术时间、总并发症发生率和术后住院时间较低。总结:小儿拔管应分阶段进行。理想的拔管方案应该是安全和方便的,不需要使用过多的医疗资源。基于患者群体或机构资源,协议可能存在差异,但每个机构内明确描述的协议对于长期持续的护理和质量改进至关重要。需要进一步的研究来确定拔管前谁将从PSG中受益最大的选择标准,以指导这一有限资源的分配。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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来源期刊
CiteScore
2.90
自引率
0.00%
发文量
96
审稿时长
6-12 weeks
期刊介绍: Current Opinion in Otolaryngology & Head and Neck Surgery is a bimonthly publication offering a unique and wide ranging perspective on the key developments in the field. Each issue features hand-picked review articles from our team of expert editors. With eleven disciplines published across the year – including maxillofacial surgery, head and neck oncology and speech therapy and rehabilitation – every issue also contains annotated references detailing the merits of the most important papers.
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