Waddell A, Appleford R, Dunning C, Papsin B C, Bailey C M
Department of Otolaryngology, Great Ormond Street Hospital for Children NHS Trust, London, UK.
Int J Pediatr Otorhinolaryngol. 1997 Mar 6;39(2):111-8. doi: 10.1016/s0165-5876(96)01473-5.
Ward decannulation is the eventual endpoint for the majority of the 40 children managed by tracheostomy at Great Ormond Street Hospital each year. Our previous protocol dictated a 10 day stay in hospital for the 25 children decannulated annually. The aim of this retrospective study was to determine the minimum safe duration for this inpatient stay. In addition, we hoped to identify any factors which might distinguish potentially successful candidates from those likely to fail decannulation. Of 104 patients decannulated between January 1991 and January 1996, complete nursing and medical records were retrieved for 84 children. These notes were retrospectively reviewed and in this group of patients there were 101 attempted decannulations. Information about the initial pathology, interim course and details of the decannulation were collected. Summary statistics were generated. There was no relation between initial pathology or duration of tracheostomy and eventual success or failure of decannulation. Observations by the nursing staff of restlessness, anxiety and recession appeared more frequently in children who eventually failed decannulation. All failures occurred within 48 h of the 24 h trial of tracheostomy blocking. Our results suggest that a safe decannulation protocol can allow discharge after day five.
对于每年在大奥蒙德街医院接受气管切开术治疗的40名儿童中的大多数来说，病房拔管是最终目标。我们之前的方案规定，每年接受拔管的25名儿童需住院10天。这项回顾性研究的目的是确定这种住院治疗的最短安全时长。此外，我们希望找出可能区分拔管潜在成功候选者和可能失败候选者的任何因素。在1991年1月至1996年1月期间接受拔管的104例患者中，检索到了84名儿童完整的护理和医疗记录。对这些记录进行了回顾性审查，在这组患者中有101次拔管尝试。收集了有关初始病理、中间病程和拔管细节的信息。生成了汇总统计数据。初始病理或气管切开术时长与最终拔管成功或失败之间没有关联。护理人员观察到，最终拔管失败的儿童中烦躁不安、焦虑和病情反复更为常见。所有失败均发生在气管切开封堵24小时试验后的48小时内。我们的结果表明，一个安全的拔管方案可以允许在第5天后出院。
