title: Tracheostomy decannulation at the Royal Hospital for Sick Children in Glasgow: Predictors of success and failure.
abstract: BACKGROUND
  Tracheostomy techniques, indications and care are extensively covered in the literature. However, little is written about the process of removing the tracheostomy tube. At the Royal Hospital for Sick Children in Glasgow we use a stepwise ward-based protocol for safe tracheostomy decannulation. Our aim therefore was to review all the paediatric tracheostomy decannulations that we attempted over the last 3 years to evaluate our protocol, to determine our success rate and to see whether any modifications to the protocol are required.
  
  
  METHODS
  We reviewed all patients who had undergone ward decannulation between January 2012 and May 2015. We extracted data from clinical records including patient characteristics, indications for tracheostomy, timing of decannulation and success or failure of the process.
  
  
  RESULTS
  The 45 children in the study underwent 57 attempts at decannulation during the study period. 25 were male (56%) and 20 were female (44%), and they were aged between 1 day and 16 years 6 months at the time of the original tracheostomy operation. 33 attempts were successful (58%). 10 children had more than one attempt at decannulation. Children were found to fail at every stage of the protocol, with the commonest point of failure being day 2 when the tracheostomy tube was capped.
  
  
  CONCLUSIONS
  We have demonstrated that our current protocol for ward decannulation is effective and safe, and that all five days of the protocol are required.
authors.affiliation: Medical School, University of Dundee, United Kingdom. Electronic address: f.m.beaton@dundee.ac.uk.
authors.forename: Fiona
authors.initials: F
authors.lastname: Beaton
authors.affiliation: Department of Paediatric Otolaryngology, Royal Hospital for Children, Glasgow, United Kingdom.
authors.forename: Tracy-Anne
authors.initials: TA
authors.lastname: Baird
authors.affiliation: Department of Paediatric Otolaryngology, Royal Hospital for Children, Glasgow, United Kingdom.
authors.forename: W Andrew
authors.initials: WA
authors.lastname: Clement
authors.affiliation: Department of Paediatric Otolaryngology, Royal Hospital for Children, Glasgow, United Kingdom.
authors.forename: Haytham
authors.initials: H
authors.lastname: Kubba
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D002985:Clinical Protocols; D020878:Device Removal / Q000379:methods*; D005260:Female; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D012189:Retrospective Studies; D012606:Scotland; D014139:Tracheostomy
keywords: Children; Decannulation; Paediatrics; Tracheostomy