Use of polysomnography to assess safe decannulation in children

A. Ioana Cristea, Hasnaa E. Jalou, Deborah C. Givan, Stephanie Davis, James E. Slaven, Veda L. Ackerman

Research output: Contribution to journalArticle

13 Citations (Scopus)

Abstract

Background: Tracheostomy is a lifesaving procedure to secure the airway and provide respiratory support. The decision to decannulate has classically been an individual physician decision without consensus among experts. The objective of this retrospective study was to assess the safety and efficacy of a standard institutional protocol that utilizes the sleep laboratory to assist in the decannulation process. Methods: Between 2006 and 2013, patients were identified using a clinical database of decannulation studies. A protocol, finalized in 2005, was implemented for each decannulation attempt. In brief, all patients eligible for decannulation based on physician's assessment undergoes bronchoscopy. Once bronchoscopy findings reveal that the patient's airway is free of significant obstruction, decannulation is conducted in the sleep laboratory. The stoma is covered by an occlusive dressing and respiratory parameters are measured awake and asleep during the day and overnight by polysomnogram (PSG). The patient undergoes re-cannulation if the study shows significant obstruction, hypoventilation, or prolonged desaturation. Results: A total of 210 decannulation attempts were performed on 189 patients (16 patients had multiple attempts). One hundred sixty-seven (79.5%) decannulation attempts were successful. Of those successfully decannulated, four (2.4%) were recannulated within 6 months. PSG parameters, specifically the apnea-hypopnea index, percent of total sleep time with oxygen saturation levels less than 90%, and lowest oxygen saturation levels were significantly associated with successful decannulation. No deaths occurred. Conclusions: We present a safe and successful decannulation protocol that includes bronchoscopy coupled with PSG evaluation of the patient with the stoma decannulated and covered by an occlusive dressing. Pediatr Pulmonol. 2016;51:796–802.

Original languageEnglish (US)
Pages (from-to)796-802
Number of pages7
JournalPediatric Pulmonology
Volume51
Issue number8
DOIs
StatePublished - Aug 1 2016

Fingerprint

Polysomnography
Bronchoscopy
Occlusive Dressings
Sleep
Oxygen
Physicians
Hypoventilation
Tracheostomy
Apnea
Catheterization
Consensus
Retrospective Studies
Databases
Safety

Keywords

  • polysomnography
  • tracheostomy decannulation

ASJC Scopus subject areas

  • Pediatrics, Perinatology, and Child Health
  • Pulmonary and Respiratory Medicine

Cite this

Cristea, A. I., Jalou, H. E., Givan, D. C., Davis, S., Slaven, J. E., & Ackerman, V. L. (2016). Use of polysomnography to assess safe decannulation in children. Pediatric Pulmonology, 51(8), 796-802. https://doi.org/10.1002/ppul.23395

Use of polysomnography to assess safe decannulation in children. / Cristea, A. Ioana; Jalou, Hasnaa E.; Givan, Deborah C.; Davis, Stephanie; Slaven, James E.; Ackerman, Veda L.

In: Pediatric Pulmonology, Vol. 51, No. 8, 01.08.2016, p. 796-802.

Research output: Contribution to journalArticle

Cristea, AI, Jalou, HE, Givan, DC, Davis, S, Slaven, JE & Ackerman, VL 2016, 'Use of polysomnography to assess safe decannulation in children', Pediatric Pulmonology, vol. 51, no. 8, pp. 796-802. https://doi.org/10.1002/ppul.23395
Cristea AI, Jalou HE, Givan DC, Davis S, Slaven JE, Ackerman VL. Use of polysomnography to assess safe decannulation in children. Pediatric Pulmonology. 2016 Aug 1;51(8):796-802. https://doi.org/10.1002/ppul.23395
Cristea, A. Ioana ; Jalou, Hasnaa E. ; Givan, Deborah C. ; Davis, Stephanie ; Slaven, James E. ; Ackerman, Veda L. / Use of polysomnography to assess safe decannulation in children. In: Pediatric Pulmonology. 2016 ; Vol. 51, No. 8. pp. 796-802.
@article{6a4f8b50a106410481b4ed3b8428aa95,
title = "Use of polysomnography to assess safe decannulation in children",
abstract = "Background: Tracheostomy is a lifesaving procedure to secure the airway and provide respiratory support. The decision to decannulate has classically been an individual physician decision without consensus among experts. The objective of this retrospective study was to assess the safety and efficacy of a standard institutional protocol that utilizes the sleep laboratory to assist in the decannulation process. Methods: Between 2006 and 2013, patients were identified using a clinical database of decannulation studies. A protocol, finalized in 2005, was implemented for each decannulation attempt. In brief, all patients eligible for decannulation based on physician's assessment undergoes bronchoscopy. Once bronchoscopy findings reveal that the patient's airway is free of significant obstruction, decannulation is conducted in the sleep laboratory. The stoma is covered by an occlusive dressing and respiratory parameters are measured awake and asleep during the day and overnight by polysomnogram (PSG). The patient undergoes re-cannulation if the study shows significant obstruction, hypoventilation, or prolonged desaturation. Results: A total of 210 decannulation attempts were performed on 189 patients (16 patients had multiple attempts). One hundred sixty-seven (79.5{\%}) decannulation attempts were successful. Of those successfully decannulated, four (2.4{\%}) were recannulated within 6 months. PSG parameters, specifically the apnea-hypopnea index, percent of total sleep time with oxygen saturation levels less than 90{\%}, and lowest oxygen saturation levels were significantly associated with successful decannulation. No deaths occurred. Conclusions: We present a safe and successful decannulation protocol that includes bronchoscopy coupled with PSG evaluation of the patient with the stoma decannulated and covered by an occlusive dressing. Pediatr Pulmonol. 2016;51:796–802.",
keywords = "polysomnography, tracheostomy decannulation",
author = "Cristea, {A. Ioana} and Jalou, {Hasnaa E.} and Givan, {Deborah C.} and Stephanie Davis and Slaven, {James E.} and Ackerman, {Veda L.}",
year = "2016",
month = "8",
day = "1",
doi = "10.1002/ppul.23395",
language = "English (US)",
volume = "51",
pages = "796--802",
journal = "Pediatric Pulmonology",
issn = "8755-6863",
publisher = "Wiley-Liss Inc.",
number = "8",

}

TY - JOUR

T1 - Use of polysomnography to assess safe decannulation in children

AU - Cristea, A. Ioana

AU - Jalou, Hasnaa E.

AU - Givan, Deborah C.

AU - Davis, Stephanie

AU - Slaven, James E.

AU - Ackerman, Veda L.

PY - 2016/8/1

Y1 - 2016/8/1

N2 - Background: Tracheostomy is a lifesaving procedure to secure the airway and provide respiratory support. The decision to decannulate has classically been an individual physician decision without consensus among experts. The objective of this retrospective study was to assess the safety and efficacy of a standard institutional protocol that utilizes the sleep laboratory to assist in the decannulation process. Methods: Between 2006 and 2013, patients were identified using a clinical database of decannulation studies. A protocol, finalized in 2005, was implemented for each decannulation attempt. In brief, all patients eligible for decannulation based on physician's assessment undergoes bronchoscopy. Once bronchoscopy findings reveal that the patient's airway is free of significant obstruction, decannulation is conducted in the sleep laboratory. The stoma is covered by an occlusive dressing and respiratory parameters are measured awake and asleep during the day and overnight by polysomnogram (PSG). The patient undergoes re-cannulation if the study shows significant obstruction, hypoventilation, or prolonged desaturation. Results: A total of 210 decannulation attempts were performed on 189 patients (16 patients had multiple attempts). One hundred sixty-seven (79.5%) decannulation attempts were successful. Of those successfully decannulated, four (2.4%) were recannulated within 6 months. PSG parameters, specifically the apnea-hypopnea index, percent of total sleep time with oxygen saturation levels less than 90%, and lowest oxygen saturation levels were significantly associated with successful decannulation. No deaths occurred. Conclusions: We present a safe and successful decannulation protocol that includes bronchoscopy coupled with PSG evaluation of the patient with the stoma decannulated and covered by an occlusive dressing. Pediatr Pulmonol. 2016;51:796–802.

AB - Background: Tracheostomy is a lifesaving procedure to secure the airway and provide respiratory support. The decision to decannulate has classically been an individual physician decision without consensus among experts. The objective of this retrospective study was to assess the safety and efficacy of a standard institutional protocol that utilizes the sleep laboratory to assist in the decannulation process. Methods: Between 2006 and 2013, patients were identified using a clinical database of decannulation studies. A protocol, finalized in 2005, was implemented for each decannulation attempt. In brief, all patients eligible for decannulation based on physician's assessment undergoes bronchoscopy. Once bronchoscopy findings reveal that the patient's airway is free of significant obstruction, decannulation is conducted in the sleep laboratory. The stoma is covered by an occlusive dressing and respiratory parameters are measured awake and asleep during the day and overnight by polysomnogram (PSG). The patient undergoes re-cannulation if the study shows significant obstruction, hypoventilation, or prolonged desaturation. Results: A total of 210 decannulation attempts were performed on 189 patients (16 patients had multiple attempts). One hundred sixty-seven (79.5%) decannulation attempts were successful. Of those successfully decannulated, four (2.4%) were recannulated within 6 months. PSG parameters, specifically the apnea-hypopnea index, percent of total sleep time with oxygen saturation levels less than 90%, and lowest oxygen saturation levels were significantly associated with successful decannulation. No deaths occurred. Conclusions: We present a safe and successful decannulation protocol that includes bronchoscopy coupled with PSG evaluation of the patient with the stoma decannulated and covered by an occlusive dressing. Pediatr Pulmonol. 2016;51:796–802.

KW - polysomnography

KW - tracheostomy decannulation

UR - http://www.scopus.com/inward/record.url?scp=84990213239&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84990213239&partnerID=8YFLogxK

U2 - 10.1002/ppul.23395

DO - 10.1002/ppul.23395

M3 - Article

C2 - 26919704

AN - SCOPUS:84990213239

VL - 51

SP - 796

EP - 802

JO - Pediatric Pulmonology

JF - Pediatric Pulmonology

SN - 8755-6863

IS - 8

ER -