Kolb Caroline M, Halbert Kelly, Xiao Wendi, Strang Abigail R, Briddell Jenna W
Division of Pediatric Otolaryngology, Nemours/Alfred I. duPont Hospital for Children, Wilmington, Delaware, USA.
Department of Otolaryngology-Head and Neck Surgery, Tripler Army Medical Center, Honolulu, Hawaii, USA.
Pediatr Pulmonol. 2021 Aug;56(8):2761-2768. doi: 10.1002/ppul.25170. Epub 2021 Feb 23.
There is a paucity of published literature identifying patients at higher risk of decannulation failure. The purpose of this study is to evaluate patient factors that may predict successful decannulation of pediatric tracheostomy patients and analyze factors contributing to tracheostomy decannulation failures.
A retrospective chart review of tracheostomy outcomes was conducted at a pediatric referral hospital. Successful and failed decannulations were compared using the following patient variables: age at tracheostomy, sex, ethnicity, gestational age and weight, the primary indication for tracheostomy, comorbidities, age at decannulation attempt, polysomnography data, and status of airway before decannulation as assessed endoscopically by airway team.
Four hundred thirty-nine tracheostomies were performed over the 18-year period with 173 decannulation attempts. The overall rate of successful decannulation on the first attempt was 91.9% (159 of 173), with an eventual decannulation success rate of 97.1% (168 of 173). Compared with failed decannulations, the patients with successful decannulations had a shorter duration of tracheostomy and no medical comorbidities. Gestational age and weight approached, but did not achieve, statistical significance. After 25 months with a tracheostomy, approximately 50% of patients are decannulated with very few decannulations occurring after 75 months. The overall mortality rate in this cohort was 18.6% (78 of 420) with a tracheostomy-related mortality rate of 0.95% (4 of 420).
The decannulation protocol at this institution is successful nearly 92% of the time. Fewer medical comorbidities, shorter duration of tracheostomy placement, and older gestational age may improve the likelihood of successful decannulation. Future studies are needed to determine the optimal timing and workup to evaluate patients for decannulation.
目前已发表的文献中，关于确定脱管失败风险较高患者的研究较少。本研究旨在评估可能预测小儿气管造口术患者脱管成功的患者因素，并分析导致气管造口术脱管失败的因素。
在一家儿科转诊医院对气管造口术结果进行回顾性病历审查。使用以下患者变量比较脱管成功和失败的情况：气管造口术时的年龄、性别、种族、胎龄和体重、气管造口术的主要指征、合并症、脱管尝试时的年龄、多导睡眠图数据，以及气道团队在内镜检查下评估的脱管前气道状况。
在18年期间共进行了439例气管造口术，其中173例进行了脱管尝试。首次脱管成功的总体率为91.9%（173例中的159例），最终脱管成功率为97.1%（173例中的168例）。与脱管失败的患者相比，脱管成功的患者气管造口术持续时间较短，且无内科合并症。胎龄和体重接近但未达到统计学意义。气管造口术后25个月，约50%的患者脱管，75个月后脱管的患者很少。该队列的总体死亡率为18.6%（420例中的78例），气管造口术相关死亡率为0.95%（420例中的4例）。
该机构的脱管方案近92%的时间是成功的。较少的内科合并症、较短的气管造口术放置时间和较大的胎龄可能会提高脱管成功的可能性。未来需要进行研究以确定评估患者脱管的最佳时机和检查方法。
