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PubMed1978

Tracheostomy decannulation.

Tracheostomy in pediatric patients involves major morbidity that is often reflected in prolonged decannulation difficulty. A review of 123 consecutive pediatric tracheostomies shows that 44 patients experienced such difficulties. Among those patients suffering decannulation delay, subglottic stenosis had developed in 39%, tracheal granuloma in 25%, fused cords in 11%, and temporary laryngeal abductor failure in 25%. Although the overall incidence of decannulation failure is high, more than 60% of those patients affected respond to treatment when diagnosis is prompt and accurate. In this regard, the laryngologist may play a central role in the management of the pediatric decannulation process.

Airway Obstruction↗

PubMed2026

Oro-esophageal feeding for tracheostomized patients with severe traumatic brain injury: a randomized controlled trial.

BACKGROUND: This study reports the clinical effects of intermittent oro-esophageal tube feeding (IOE) versus nasogastric tube feeding (NGT) on nutritional status, aspiration pneumonia, decannulation, and level of consciousness in tracheostomized patients with severe traumatic brain injury (sTBI). METHODS: A randomized controlled trial was conducted between March 2024 and October 2025 in China and included tracheostomized patients with sTBI. Participants were randomized 1:1 to the intervention and control groups for 28-day interventions. IOE or NGT was used for nutritional supports, respectively. The primary outcome was nutritional status, including hemoglobin, albumin, prealbumin and body mass index. The secondary outcomes included aspiration pneumonia, decannulation, and level of consciousness assessed using the Glasgow Coma Scale (GCS). Generalized linear mixed-effects models, generalized estimating equations, and Cox regression were used for data analyze. RESULTS: A total of 104 participants were included in the analysis. After intervention, significant interaction effects were observed in hemoglobin (β = 5.272, 95% CI: 2.707, 7.837), albumin (β = 3.675, 95% CI: 1.854, 5.496), prealbumin (β = 11.835, 95% CI: 6.623, 17.047), body mass index (β = 1.719, 95% CI: 0.868, 2.569), the GCS (β = 0.981, 95% CI: 0.572, 1.390), and aspiration pneumonia (OR= 0.304, 95% CI: 0.133, 0.693). The Cox model revealed that group significantly influenced the decannulation outcomes [HR (95% CI) =5.556 (3.197, 9.657), p < 0.001]. CONCLUSIONS: In tracheostomized patients with sTBI who received routine treatment, IOE is more conducive to decannulation and the improvement in nutritional status, aspiration pneumonia, and level of consciousness than NGT. CLINICAL TRIAL REGISTRATION: Prospectively registered at ClinicalTrials.gov (NCT06328985, 03/18/2024, clinicaltrials.gov/study/NCT06328985).

Humans↗

PubMed1978

Pediatric tracheostomy. II. Radiographic features of difficult decannulations.

A difficult decannulation was the principal complication in 12 of 30 consecutive infants and children with tracheostomies. Simple radiographic studies permitted accurate diagnoses which correlated with bronchoscopy. In eight patients an endotracheal lesion was caused directly by the tracheostomy, a risk of complication higher than expected. These obstructions were usually granulomas at the superior margin of the stoma; resectable and nonresectable granulomas could not be differentiated radiographically. Four patients had a primary tracheal or laryngeal obstruction which preceded the tracheostomy and complicated decannulation; these included adhesions of the vocal cords and subglottic trachea and posed difficulties in radiographic diagnosis. In no case was dependency on tracheostomy entirely due to emotional causes.

Bronchoscopy↗

PubMed1978

Pediatric tracheostomy. I. Radiographic features of normal healing.

Serial radiographic studies were used in a prospective study of tracheostomy healing in 30 consecutive infants and children. The examinations were simple, required no anesthesia or sedation, and were coordinated with decannulation of the tracheostomy. In 22 of 30, the tracheostomy site healed normally; in four of these 22 patients the primary cause for obstruction persisted. In 19 of 22 the radiologic study served as an alternative to bronchoscopy before decannulation. Particularly in small infants, the features of normal healing vary in the first days; temporary narrowing of the tracheal lumen can occur at the stomal site and mimic early granulations. After 1 month the trachea is normal except for minor changes at the previous site of the tracheostomy.

Bronchoscopy↗

PubMed1978

Infant tracheostomy. A new look with a solution to the difficult cannulation problem.

Although most infant airway and ventilatory problems will be best solved by the use of endotracheal tubes, clear-cut indications for tracheostomy exist. Past reticence to use tracheostomy for infants has been due mainly to the fear of decannulation problems. Recognition of obstructive airway lesions, particularly the lumen-narrowing tracheal stomal granuloma, has been facilitated by the routine use of the newer infant bronchoscopes with optical telescopes. Successful decannulation begins with proper tracheostomy technique, and continues through tracheostomy management and a well-conceived decannulation program. Decannulation should include evaluation of the structure and function of the airway endoscopically and it may include translaryngeal endoscopic resection or formal surgical removal of any obstructing lesions. Experienced nursing personnel are essential to the entire program.

Airway Obstruction↗

PubMed2026

Comparison of Adult Tracheostomy Outcomes Before and After Implementation of a Dedicated Tracheostomy Team.

OBJECTIVE: (A) Determine patient and institutional factors associated with increased length of stay (LOS) and complications of tracheostomy, (B) Develop data-driven quality improvement in tracheostomy care. DESIGN: Mixed methods protocol used cross-sectional survey assessing institutional trends in tracheostomy-specific care. Retrospective chart review compared tracheostomy patient outcomes prior to and during implementation of a multidisciplinary tracheostomy care team and standardized guidelines. PARTICIPANTS: Patients undergoing tracheostomy from January 2019 to December 2021 at a tertiary hospital. METHODS: Patient factors, procedure type and indication, tracheostomy tube size, management timeline, insurance, and disease severity using Acute Physiology and Chronic Health Evaluation II (APACHE II) score were analyzed for associations with LOS and adverse events. Multivariate analyses controlled for APACHE II score and payer source. LOS and complications were compared between patients before and during implementation of multidisciplinary tracheostomy care team and standardized guidelines. RESULTS: Three-hundred and eighteen patients met criteria with a 21.7% complication rate, average LOS of 24 days (SD = 28.523), and median LOS post-tracheostomy of 14 days (IQR 7, 29). Departments without standardized protocols had greater LOS (F[1,316] = 28.706, P < .001]) and complication odds (OR = 2.92, P = .015, 95% CI[1.231, 6.930]). Larger tracheostomy tube size was linked to increased LOS (β = .253, t(314) = 4.741, P < .001, 95% CI[4.137, 10.081]). Delays from ventilation discontinuation to cuffless tube exchange and decannulation correlated with increased LOS (β = .406, t(184) = 6.321, P < .001, 95% CI[.928, 1.771]); (β = .554, t(129) = 7.625, P < .001, 95% CI[1.008, 1.715]). When focusing on a single department, comparing 2019 patients to 2021 patients (pre- and post-guideline and care team), overall, LOS decreased from 33.08 to 30.83 days (P = .586). When excluding patients discharged on a ventilator, the 2019 group had average LOS of 37.938 days versus 33.41 days in 2021 (P = .344). CONCLUSIONS: Standardized tracheostomy care guidelines and multidisciplinary care teams are critical to improving institutional outcomes. Data-driven approaches to quality improvement ensure efficient and targeted methods to improving patient care. LEVEL OF EVIDENCE: 4.

Humans↗

PubMed1979

The pediatric tracheostomy: simple roentgen studies of morphology and function.

Following tracheostomy, simple roentgen studies coordinated with decannulation permit accurate evaluation of the pediatric patient. These studies require alertness to the child's clinical condition as well as a selective, monitored roentgen technique. The conventional lateral neck radiograph and the high-kV frontal tracheogram complete the evaluation in most cases. Fluoroscopy and xerography can be of additional value if decannulation is difficult, though xerography should be used only to confirm the presence of a granuloma seen on the conventional radiograph.

Airway Obstruction↗

PubMed1979

Management of the flap tracheostomy. An experimental study.

The flap tracheostomy was studied in 25 adult canines to further investigate its best management. Tracheostomies were performed by employing the inverted U flap incision in the trachea. After decannulation, the flap was either formally resewn to the trachea, bluntly dissected from the surrounding soft tissues, or left in place. The time required for epidermal closure over the tracheostomy site was measured, along with fixation of skin to soft tissues in the area. Histologic examinations were made, and tracheal dimensions were calculated on sections through the stomal area. More rapid skin closure and less soft tissue fixation occurred in animals that underwent resuturing or release of the tracheal flap. In all groups, cartilage viability and regrowth were noted. Tracheal diameters were maintained in all groups, but smoother contouring was seen with resuturing. Additional support for the flap tracheostomy is provided from this animal experimentation.

Animals↗

PubMedDate not supplied

Subglottic stenosis in infants and children.

Of 158 cases of subglottic stenosis 115 were congenital and 43 acquired. Current follow-up has been obtained in 146 (92%) which constitutes the determinate group. Although stridor was the most common presenting symptom of the congenital group, 34% presented with recurrent or prolonged episodes of croup. Tracheotomy was required in 47 of the 107 determinate cases (44%). Further management of the congenital cases was based on the experience that children outgrow this disorder; periodic dilatation may augment the natural process. Of those infants and children tracheotomized, all but five have been decannulated, and there was one death - a mortality rate of 2.1%. Acquired subglottic stenosis proved to be a more difficult management problem. Tracheotomy was necessary in 38 of the 39 determinate cases (97%). Repeated active dilatations for prolonged periods were usually required as well as endoscopic removal of granulation tissue. Of those infants and children tracheotomized, all but eight have been decannulated. There were nine deaths; five were due to unrelated underlying disease; four were attributable to complications of long-term tracheostomy. Thus, in the entire series, 85 infants and children required tracheotomy and five deaths may be attributable to long-term tracheostomy complications - a mortality rate of 5.9%.

Child↗