A Retrospective Study of Indications and Procedures for Pediatric Tracheostomy Decannulation

Abstract

Purpose: Clinical practice in pediatric tracheostomy decannulation varies widely because evidence-based guidelines are limited. We reviewed a decade of experience in our department to describe current procedures and outcomes, and to establish a standardized protocol with clear indications and steps.

Methods: We included patients aged ≤15 years who underwent decannulation attempts in our department between January 2013 and November 2023. Patients who underwent laryngotracheoplasty were excluded. Our standard approach consists of a staged downsizing of the tracheostomy tube, capping trials, and rigid bronchoscopy, followed by inpatient decannulation. Since 2022, speech cannulas have been used to support aspiration prevention and speech practice. However, the order and duration of each step were not standardized. We retrospectively reviewed medical records to evaluate procedures and decannulation outcomes, and performed logistic regression to identify potential risk factors for intratracheal granulation that may hinder decannulation.

Results: Thirty-seven decannulation attempts were performed in 33 patients. The median age at decannulation was 5 years, and the success rate was 86.5%. Rigid bronchoscopy was performed before decannulation in 91.9% of attempts. Tracheal granulation was treated in 23.5% of those patients, and speech cannulas were used in 32.4%. The median capping duration, post-decannulation observation, and time to decannulation were 6, 4, and 90 days, respectively. No significant factors were associated with tracheal granulation.

Conclusions: Our findings indicate that implementing a protocol is essential for efficient and timely decannulation. On the basis of these findings, we developed a new pediatric decannulation protocol incorporating a 6-day hospitalization along with the routine use of a speech cannula and speech valve.