title: A Pediatric Decannulation Protocol: Outcomes of a 10-Year Experience.
abstract: OBJECTIVE
  (1) Describe an institutional protocol that focuses on the essential steps for decannulation of pediatric patients with long-term tracheostomies. (2) Discuss the preliminary observations of the safety of this protocol in regard to decannulation failures and successes in a selected patient population.
  
  
  METHODS
  Case series with chart review.
  
  
  METHODS
  A tertiary pediatric hospital.
  
  
  METHODS
  Subjects were pediatric patients with chronic tracheostomies undergoing decannulation. Ages ranged from 1 to 17 years old. Indications for initial tracheostomy included chronic lung disease, airway obstruction, and trauma.
  
  
  METHODS
  Subjects underwent decannulation attempt following a specific protocol. The protocol consisted of operative laryngoscopy and bronchoscopy. If the airway was deemed adequate for decannulation at that time, the tracheotomy tube was removed, and the child was monitored overnight; the patient was considered for discharge the following day if no complications arose. No routine capping, downsizing, or polysomnography was performed.
  
  
  RESULTS
  Thirty-five patients fit the criteria and were decannulated within 24 hours of endoscopy. Successful decannulation served as the primary outcome. Of the 35 decannulated patients, 54% (n = 19) were discharged the day following decannulation and another 37% (n = 13) on postdecannulation day 2. There were no acute failures or readmissions. Average inpatient stay for those decannulated was 1.8 days.
  
  
  CONCLUSIONS
  This study describes the preliminary observations of a decannulation protocol in a small subset of patients. The protocol resulted in no acute failures and offers a conservative approach to resource utilization, making it unique when compared with other published protocols.
authors.affiliation: Children's ENT and Facial Plastic Surgery, Children's Hospitals and Clinics of Minnesota, Minneapolis, Minnesota, USA Department of Otolaryngology, University of Minnesota, Minneapolis, Minnesota, USA wirtz039@umn.edu.
authors.forename: Nicholas
authors.initials: N
authors.lastname: Wirtz
authors.affiliation: Children's ENT and Facial Plastic Surgery, Children's Hospitals and Clinics of Minnesota, Minneapolis, Minnesota, USA Department of Otolaryngology, University of Minnesota, Minneapolis, Minnesota, USA.
authors.forename: Robert J
authors.initials: RJ
authors.lastname: Tibesar
authors.affiliation: Children's ENT and Facial Plastic Surgery, Children's Hospitals and Clinics of Minnesota, Minneapolis, Minnesota, USA Department of Otolaryngology, University of Minnesota, Minneapolis, Minnesota, USA.
authors.forename: Timothy
authors.initials: T
authors.lastname: Lander
authors.affiliation: Children's ENT and Facial Plastic Surgery, Children's Hospitals and Clinics of Minnesota, Minneapolis, Minnesota, USA Department of Otolaryngology, University of Minnesota, Minneapolis, Minnesota, USA.
authors.forename: James
authors.initials: J
authors.lastname: Sidman
mesh_terms: D000293:Adolescent; D001999:Bronchoscopy; D002648:Child; D002675:Child, Preschool; D002985:Clinical Protocols; D020878:Device Removal; D005260:Female; D006776:Hospitals, Pediatric; D006801:Humans; D007223:Infant; D007828:Laryngoscopy; D008297:Male; D014139:Tracheostomy / Q000295:instrumentation*; D016896:Treatment Outcome
keywords: decannulation; protocol; tracheostomy