Tracheostomy decannulation protocol in a tertiary pediatric hospital
DOI:
https://doi.org/10.34631/sporl.2058Keywords:
decannulation, pediatric tracheotomy, protocolAbstract
Introduction - Pediatric tracheostomy is associated with significant morbidity, with decannulation being the primary outcome, as soon as the underlying indication for the procedure is resolved. There is great variability in pediatric decannulation protocols, making it imperative to create a protocol that reflects the reality of Portuguese hospitals.Objectives - To describe the decannulation protocol at Hospital Dona Estefânia, highlighting the essential steps for the decannulation of pediatric patients with long-term tracheostomies. Discuss preliminary observations about the safety and efficacy of this protocol.
Material and Methods - A systematic literature review was carried out in the MEDLINE, Cochrane Central Register of Controlled Trials and Cumulative Index to Nursing and Allied Health Literature databases, based on the PRISMA model (Preferred Reporting Items for Systematic Reviews and Meta-Analyses), selecting papers published between January 2011 and December 2021. Based on this review, the decannulation protocol at Hospital Dona Estefânia was constructed.
Results - A total of 22 studies were reviewed, including 2387 patients. Modifications to the tracheostomy tube included the use of a cap (n = 18, 82%), size reduction (n = 12, 55%) and use of a fenestrated tube (n = 1, 5%). Measurements of respiratory gas exchange prior to decannulation included oximetry (n = 9, 41%), capnography (n = 3, 14%), blood gases (n = 2, 9%) and polysomnography (n = 14, 64%). Laryngotracheoscopy was routinely used in 21 of the 22 (95.5%) protocols. After decannulation, patients are transferred to the ward or intensive care unit, most of them staying in room air and for an observation period of no more than 48 hours (77% of protocols). In the proposed protocol for HDE, the child considered fit for decannulation must be without the need for ventilatory support, tolerate the reduction in the size of the tracheostomy tube and the use of a lid, without desaturation or signs of respiratory difficulty, daytime, nighttime or in exercise.
Conclusions - Evidence-based guidelines that standardize pediatric tracheostomy care and the decannulation process remain a priority.
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