Role of polysomnography in the development of an algorithm for planning tracheostomy decannulation.
OBJECTIVE
To examine the role of polysomnography (PSG) in helping determine readiness of tracheostomized patients for decannulation.


METHODS
Case series with chart review of pediatric patients who underwent PSG with tracheostomy tube in place with the goal of decannulation.


METHODS
Tertiary care pediatric center.


METHODS
Twenty-eight tracheostomized patients who underwent PSG from January 2006 to March 2012 were included. Outcome measures were successful decannulation, PSG results, surgical procedures, and medical comorbidities.


RESULTS
Of the 28 patients, 20 (71.4%) were decannulated and 8 (28.6%) were not. One (3.6%) patient failed long-term decannulation. The average apnea-hypopnea index (AHI) with a capped tracheostomy for those successfully decannulated was 2.75 (range, 0.6-7.6), while the AHI for those not decannulated was 15.99 (range, 3.2-62). Factors associated with success or failure to decannulate were assessed, and an algorithm was developed to plan for successful decannulation. Laryngotracheal reconstruction was a significant factor in those successfully decannulated. Those who were not decannulated had multiple medical comorbidities, multilevel airway obstruction, need for additional surgery, or chronic need for pulmonary toilet.


CONCLUSIONS
Polysomnography may be a useful adjunctive study in the process of determining a patient's readiness for decannulation. Our current algorithm for decannulation includes upper airway endoscopy with identification of levels of obstruction, followed by surgical correction of those obstructions; capped PSG to determine patency of the airway and help assess lung function; and overnight intensive care unit admission for capping trial, with decannulation the following day if well tolerated.
Department of Pediatric Otolaryngology, Children's Hospital of Pittsburgh of University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA.
Jacob G
JG
Robison
Department of Pediatric Otolaryngology, Children's Hospital of Pittsburgh of University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA.
Prasad John
PJ
Thottam
Department of Pediatric Otolaryngology, Children's Hospital of Pittsburgh of University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA.
Laura L
LL
Greenberg
Department of Pediatric Otolaryngology, Children's Hospital of Pittsburgh of University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA.
Raymond C
RC
Maguire
Department of Pediatric Otolaryngology, Children's Hospital of Pittsburgh of University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA.
Jeffrey P
JP
Simons
Department of Pediatric Otolaryngology, Children's Hospital of Pittsburgh of University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA Deepak.mehta@chp.edu.
Deepak K
DK
Mehta
D000465:Algorithms; D002648:Child; D020878:Device Removal; D006801:Humans; D017286:Polysomnography; D012189:Retrospective Studies; D014139:Tracheostomy / Q000295:instrumentation*
decannulation; pediatric airway; polysomnogram; tracheostomy