Abstract
Decannulating a patient on a tracheostomy is a procedure that has to be dealt with vigilantly. This study evaluated both external and telescopic/bronchoscopic findings at the peristomal level of subjects being considered for decannulation. The patients did not undergo any intervention after above observations and before attempting decannulation. Thereafter peristomal findings and their contribution towards failure to decannulate were correlated. Thirty subjects were studied prospectively, of whom 21 (70 %) demonstrated peristomal complications including granulation tissue, ulceration, mucopurulent discharge, suprastomal granulations, suprastomal collapse and suprastomal flap. Complications were more common in the younger age group (p = 0.007) as well as in tracheostomies of longer duration with mean duration >20 months (p = 0.045). However there was no statistically significant correlation between the success of decannulation and various peristomal findings. Therefore the success of decannulation in a particular case cannot always be correctly predicted by peristomal assessment.
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References
Cochrane LA, Bailey CM (2006) Surgical aspects of tracheostomy in children. Paediatr Respir Rev 7(3):169–174
White AC, Kher S, O’Connor HH (2010) When to change a tracheostomy tube. Respir Care 55(8):1069–1075
Hess DR (2005) Tracheostomy tubes and related appliances. Respir Care 50(4):497–510
Ardran GM, Caust LJ (1963) Delayed decannulation after tracheostomy in infants. J Laryngol Otol 77:555–566
Shires CB, Shete MM, Thompson JW (2009) Management of suprastomal tracheal fibroma: introduction of a new technique and comparison with other techniques. Int J Pediatr Otorhinolaryngol 73(1):67–72
Colman KL, Mandell DL, Simons JP (2010) Impact of stoma maturation on pediatric tracheostomy-related complications. Arch Otolaryngol Head Neck Surg 136(5):471–474
Negus V (1949) The comparative anatomy and physiology of the larynx, 1st edn. Heinemann, London
al-Saati A, Morrison GA, Clary RA, Bailey CM (1993) Surgical decannulation of children with tracheostomy. J Laryngol Otol 107(3):217–221
O’Connor HH, White AC (2010) Tracheostomy decannulation. Respir Care 55(8):1076–1081
Mahadevan M, Barber C, Salkeld L, Douglas G, Mills N (2007) Pediatric tracheotomy: 17 year review. Int J Pediatr Otorhinolaryngol 71(12):1829–1835
Yellon RF (2000) Totally obstructing tracheotomy-associated suprastomal granulation tissue. Int J Pediatr Otorhinolaryngol 53(1):49–55
Rosenfeld RM, Stool SE (1992) Should granulomas be excised in children with long-term tracheotomy? Arch Otolaryngol Head Neck Surg 118(12):1323–1327
Stelfox HT, Crimi C, Berra L, Noto A, Schmidt U, Bigatello LM et al (2008) Determinants of tracheostomy decannulation: an international survey. Crit Care 12(1):R26
Bach JR, Saporito LR (1996) Criteria for extubation and tracheostomy tube removal for patients with ventilatory failure. A different approach to weaning. Chest 110(6):1566–1571
Ceriana P, Carlucci A, Navalesi P, Rampulla C, Delmastro M, Piaggi G et al (2003) Weaning from tracheotomy in long-term mechanically ventilated patients: feasibility of a decisional flowchart and clinical outcome. Intensive Care Med 29(5):845–848
Yaremchuk K (2003) Regular tracheostomy tube changes to prevent formation of granulation tissue. Laryngoscope 113(1):1–10
Carr MM, Poje CP, Kingston L, Kielma D, Heard C (2001) Complications in pediatric tracheostomies. Laryngoscope 111(11 Pt 1):1925–1928
Wind J (1971) Reflections of difficult decannulation. Arch Otolaryngol. 94(5):426–431
Prescott CA (1992) Peristomal complications of paediatric tracheostomy. Int J Pediatr Otorhinolaryngol 23(2):141–149
Sue RD, Susanto I (2003) Long-term complications of artificial airways. Clin Chest Med 24(3):457–471
Engels PT, Bagshaw SM, Meier M, Brindley PG (2009) Tracheostomy: from insertion to decannulation. Can J Surg 52(5):427–433
Koitschev A, Simon C, Blumenstock G, Mach H, Graumuller S (2006) Suprastomal tracheal stenosis after dilational and surgical tracheostomy in critically ill patients. Anaesthesia 61(9):832–837
Tucker JA, Silberman HD (1972) Tracheotomy in pediatrics. Ann Otol Rhinol Laryngol 81(6):818–824
Anton-Pacheco JL, Villafruela M, Lopez M, Garcia G, Luna C, Martinez A (2008) Surgical management of severe suprastomal cricotracheal collapse complicating pediatric tracheostomy. Int J Pediatr Otorhinolaryngol 72(2):179–183
Benjamin B, Curley JW (1990) Infant tracheotomy–endoscopy and decannulation. Int J Pediatr Otorhinolaryngol 20(2):113–121
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Mukut Saharia Award for the best resident’s paper at the 35th Annual Conference of the The Association of Otolaryngologist of India, New Delhi (28th and 29th of April 2012).
Paper presentation at the 65th Annual Conference of the Association of Otolaryngologists of India (3–6th January 2013).
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Mathur, N.N., Sohliya, L.M. Pre-decannulation Peristomal Findings in Tracheostomized Cases and Their Effect on the Success of Decannulation. Indian J Otolaryngol Head Neck Surg 67 (Suppl 1), 91–97 (2015). https://doi.org/10.1007/s12070-014-0785-4
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DOI: https://doi.org/10.1007/s12070-014-0785-4