The role of polysomnography in tracheostomy decannulation of the paediatric patient

Jennifer Lee; Marlene A Soma; Arthur Y Teng; Ganesh Thambipillay; Karen A Waters; Alan T Cheng

doi:10.1016/j.ijporl.2016.01.034

The role of polysomnography in tracheostomy decannulation of the paediatric patient

Int J Pediatr Otorhinolaryngol. 2016 Apr:83:132-6. doi: 10.1016/j.ijporl.2016.01.034. Epub 2016 Feb 6.

Authors

Jennifer Lee¹, Marlene A Soma², Arthur Y Teng³, Ganesh Thambipillay³, Karen A Waters⁴, Alan T Cheng⁵

Affiliations

¹ Department of Paediatric Otolaryngology, Sydney Children's Hospital Network - Westmead Campus, Sydney, NSW, Australia. Electronic address: jennifer.w.lee@hotmail.com.
² Department of Paediatric Otolaryngology, Sydney Children's Hospital Network - Randwick Campus, Sydney, NSW, Australia; School of Women and Children's Health, University of New South Wales, Randwick, Australia.
³ School of Women and Children's Health, University of New South Wales, Randwick, Australia; Department of Sleep Medicine, Sydney Children's Hospital Network - Randwick Campus, Sydney, NSW, Australia.
⁴ Department of Respiratory Medicine, Sydney Children's Hospital Network - Westmead Campus, Sydney, NSW, Australia; Discipline of Paediatrics and Child Health, University of Sydney, Sydney, NSW, Australia.
⁵ Department of Paediatric Otolaryngology, Sydney Children's Hospital Network - Westmead Campus, Sydney, NSW, Australia; Discipline of Paediatrics and Child Health, University of Sydney, Sydney, NSW, Australia.

PMID: 26968066
DOI: 10.1016/j.ijporl.2016.01.034

Abstract

Introduction: Tracheostomy decannulation in the paediatric patient is usually considered when there is resolution or significant improvement in the original indication for the tracheostomy. The child's cardiorespiratory function needs to be optimized and assessment of the readiness for decannulation is generally by endoscopic evaluation to confirm airway patency and vocal cord mobility. Functional airway assessment procedures include downsizing the tracheostomy, adding fenestration, speaking valves and capping the tracheostomy tube. Few objective measures have been demonstrated to accurately predict the likelihood of successful decannulation. This study aims to evaluate the usefulness of polysomnography (PSG) with a capped tracheostomy tube, as an adjunct to airway endoscopy and traditional decannulation procedures, to predict decannulation outcome.

Methods: A retrospective review was conducted for patients who underwent "capped" PSG prior to a trial of tracheostomy decannulation at the Sydney Children's Hospitals Network. The charts were reviewed for clinical data and PSG results.

Results: 30 children with a total of 40 PSG reports were included in this study. There was a statistically significant difference in mean oxygen saturation, minimum oxygen saturation, total apnoea/hypopnoea index, desaturations >3%, and desaturations >3% index between those that had successful decannulation compared to failed decannulation. The measures with the greatest significance, and therefore, the best predictors of decannulation outcome were total apnoea/hypopnoea index (3.35events/h vs. 18.5events/h, p=0.004) and desaturation events (20.33 events vs. 192 events, p=0.001).

Conclusions: PSG with a capped tracheostomy tube is a useful, objective tool to complement endoscopy and functional airway assessment in the consideration of decannulation in the paediatric population.

Keywords: Laryngoscopy; Larynx; Polysomnography; Trachea; Tracheostomy; Vocal cord dysfunction.

MeSH terms

Adolescent
Child
Child, Preschool
Device Removal / adverse effects
Device Removal / methods*
Female
Humans
Infant
Laryngoscopes
Male
Polysomnography / methods*
Retrospective Studies
Sleep
Tracheostomy / adverse effects
Tracheostomy / methods*
Vocal Cords