title: Retrospective Analysis of Factors Leading to Pediatric Tracheostomy Decannulation Failure. A Single-Institution Experience.
abstract: BACKGROUND
  There is a lack of evidence regarding factors associated with failure of tracheostomy decannulation.
  
  
  OBJECTIVE
  We aimed to identify characteristics of pediatric patients who fail a tracheostomy decannulation challenge Methods: A retrospective review was performed on all patients who had a decannulation challenge at a tertiary care center from June 2006 to October 2013. Tracheostomy decannulation failure was defined as reinsertion of the tracheostomy tube within 6 months of the challenge. Data on demographics, indications for tracheostomy, home mechanical ventilation, and comorbidities were collected. Data were also collected on specific airway endoscopic findings during the predecannulation bronchoscopy and airway surgical procedures before decannulation. We attempted to predict the decannulation outcome by analyzing associations.
  
  
  RESULTS
  147 of 189 (77.8%) patients were successfully decannulated on the first attempt. Tracheostomy performed due to chronic respiratory failure decreased odds for decannulation failure (odds ratio = 0.34, 95% confidence interval = 0.15-0.77). Genetic abnormalities (45%) and feeding dysfunction (93%) were increased in the population of patients failing their first attempt. The presence of one comorbidity increased the odds of failure by 68% (odds ratio = 1.68, 95% confidence interval = 1.23-2.29). Decannulation pursuit based on parental expectation of success, rather than medically determined readiness, was associated with a higher chance of failure (P = 0.01).
  
  
  CONCLUSIONS
  Our study highlights the role of genetic abnormalities, feeding dysfunction, and multiple comorbidities in patients who fail decannulation. Our findings also demonstrate that the outcome of decannulation may be predicted by the indication for tracheostomy. Patients who had tracheostomy placed for chronic respiratory support had a higher likelihood of success. Absence of a surgically treatable airway obstruction abnormality on the predecannulation bronchoscopy increased the chances of success.
authors: 1 Department of Pediatrics and.
authors: Anuja
authors: A
authors: Bandyopadhyay
authors: 1 Department of Pediatrics and.
authors: A Ioana
authors: AI
authors: Cristea
authors: 1 Department of Pediatrics and.
authors: Stephanie D
authors: SD
authors: Davis
authors: 1 Department of Pediatrics and.
authors: Veda L
authors: VL
authors: Ackerman
authors: 2 Department of Biostatistics, Indiana University School of Medicine, Indianapolis, Indiana.
authors: James E
authors: JE
authors: Slaven
authors: 1 Department of Pediatrics and.
authors: Hasnaa E
authors: HE
authors: Jalou
authors: 1 Department of Pediatrics and.
authors: Deborah C
authors: DC
authors: Givan
authors: 1 Department of Pediatrics and.
authors: Ameet
authors: A
authors: Daftary
mesh_terms: D000293:Adolescent; D000402:Airway Obstruction / Q000601:surgery*; D001999:Bronchoscopy; D002648:Child; D002675:Child, Preschool; D002908:Chronic Disease; D020878:Device Removal; D005260:Female; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D016017:Odds Ratio; D012086:Reoperation; D012121:Respiration, Artificial; D012131:Respiratory Insufficiency / Q000628:therapy*; D012189:Retrospective Studies; D012307:Risk Factors; D063128:Tertiary Health Care; D014139:Tracheostomy; D055815:Young Adult
keywords: airway obstruction; comorbidities tracheostomy; decannulation failure; polysomnography; tracheostomy decannulation