Is Polysomnography Helpful in Preparing a Child for Decannulation?

SESSION TITLE: Sleep 1 SESSION TYPE: Original Investigation Poster PRESENTED ON: Wednesday, November 1, 2017 at 01:30 PM - 02:30 PM PURPOSE: Decannulation is the ultimate goal shared by families, providers and children with tracheostomies. Many patients have resolution of their underlying airway pathology and are able to tolerate decannulation. Various approaches exist among providers as well as institutions in approaching decannulation. This is may be due to a lack of sufficient data as well as a lack of consensus on the optimal decannulation protocol. Specifically, some centers utilize polysomnography (PSG) to determine readiness for decannulation, while others do not. To determine whether polysomnography (PSG) is helpful in determining whether a child with a tracheostomy is ready for decannulation, we reviewed the literature for data and practices on decannulation in children. METHODS: We reviewed the published literature for reports of decannulation strategies in children. The following search terms were used in PubMed: “tracheostomy decannulation protocol”, “PSG and decannulation in children”, “PSG and tracheostomy”. We compared the success rates of decannulation of those studies that performed a PSG prior to decannulation with the groups that did not. RESULTS: We found six reports of decannulation strategies describing a total of 344 decannulations. All were case series and reports of experience, or consensus statements. Four of these reports utilized PSG as part of their decannulation protocol (Group 1). Two reports did not utilize PSG (Group 2) as part of their decannulation protocol. The indications for tracheostomy were similar in both groups, predominantly prolonged intubation, upper airway obstruction tracheomalacia, chronic lung disease, craniofacial abnormalities, and neuromuscular abnormalities. The studies did not all report the same parameters, including age at time of tracheostomy, duration of tracheostomy, or anthropometric measures. However, 222 of 263 (84%) of patients in group 1 were successfully decannulated. Seventy-one of 81 (88 %) patients in Group 2 were successfully decannulated. (Chi square =0.52, p=0.47, NS) CONCLUSIONS: Over 80% of attempted decannulations are successful, without the need to replace the tracheostomy. These data suggest that polysomnography does not increase the chance of successful decannulation. We conclude that PSG may not be routinely required for all children with long term tracheostomies prior to decannulation. Larger, prospective studies are required to confirm this. Nevertheless, there are some patients who may benefit from PSG prior to decannulation, particularly those at higher risk of failed decannulation due to other comorbidities. CLINICAL IMPLICATIONS: Further studies are needed to determine if PSG is needed in decannulating children, particularly those with significant comorbidities. DISCLOSURE: The following authors have nothing to disclose: Olufunke Afolabi-Brown, Lee Brooks No Product/Research Disclosure Information