Pediatric Pulmonary and Sleep Medicine, Medical College of Wisconsin, Milwaukee, WisconsinWisconsin.
Pediatric Critical Care Medicine, Medical College of Wisconsin, Milwaukee, WisconsinWisconsin.
Pediatr Pulmonol. 2018 Nov;53(11):1549-1558. doi: 10.1002/ppul.24164. Epub 2018 Sep 24.
Background The prevalence of respiratory-technology dependent children is increasing although for most children the goal is liberation from technology. Liberation from home mechanical ventilation (HMV) and decannulation strategies vary due to the lack of clinical practice standards. The primary objective of this study was to describe our practice utilizing a polysomnography (PSG) in the liberation from respiratory-technology process. Methods Retrospective study of tracheostomized children with and without HMV who underwent an evaluation for decannulation between January 2006 and June 2016. Patient demographics, indication for tracheostomy, indication for PSG, PSG results and interventions performed after the PSG were collected. RESULTS: We identified 153 decannulation attempts in 148 children. Ninety-nine children had a tracheostomy only and 49 children had a tracheostomy with HMV. There were 190 PSGs performed. Almost two-thirds of the children (N = 92) had at least one PSG, 37 children (25%) had two and 19 children (13%) had more than 2 PSGs. Children with tracheostomy and HMV had more PSGs compared to children with tracheostomy only. PSGs were performed at four points: (1) prior to tracheostomy placement (N = 23); (2) to titrate HMV (N = 19); (3) off-HMV support (N = 43); and with a capped tracheostomy (N = 101). Most of the off-HMV PSGs (N = 39) were favorable for discontinuing HMV. About two-thirds of the capped PSGs (N = 73) were favorable for decannulation; of the unfavorable capped PSGs (N = 28), thirteen required airway surgeries following the unfavorable PSG. CONCLUSION: : Overnight PSG provides useful information to the liberation process, particularly when determining readiness for discontinuing HMV and decannulation.
尽管大多数儿童的目标是摆脱技术，但依赖呼吸技术的儿童的患病率正在增加。由于缺乏临床实践标准，从家庭机械通气（HMV）和气管切开套管去除的策略有所不同。本研究的主要目的是描述我们在从呼吸技术中解脱的过程中利用多导睡眠图（PSG）的实践。
回顾性研究了 2006 年 1 月至 2016 年 6 月期间接受气管切开套管去除评估的气管切开且有或无 HMV 的儿童。收集了患者的人口统计学资料、气管切开术的指征、PSG 的指征、PSG 结果以及 PSG 后进行的干预措施。
我们确定了 148 名儿童中的 153 次套管去除尝试。99 名儿童仅行气管切开术，49 名儿童行气管切开术加 HMV。共进行了 190 次 PSG。将近三分之二的儿童（N=92）至少进行了一次 PSG，37 名儿童（25%）进行了两次，19 名儿童（13%）进行了两次以上 PSG。与仅行气管切开术的儿童相比，行气管切开术加 HMV 的儿童进行了更多的 PSG。PSG 在四个时间点进行：（1）在气管切开术之前（N=23）；（2）在 HMV 滴定时（N=19）；（3）在脱机支持时（N=43）；和（4）气管切开套管盖好时（N=101）。大多数脱机 PSG（N=39）有利于停止 HMV。大约三分之二的带盖 PSG（N=73）有利于套管去除；在不利的带盖 PSG 中（N=28），13 例在不利的 PSG 后需要气道手术。
夜间 PSG 为解脱过程提供了有用的信息，特别是在确定停止 HMV 和套管去除的准备情况时。
