Dekanilacija pri otrocih: predstavitev protokola in naših izkušenj

Background: Tracheostomy increases the morbidity of children, so it is desirable to remove the tracheal cannula (TC) or perform the decannulation as soon as possible. The clinical assessment ensures the child meets the conditions for decannulation. This is followed by decannulation, performed in a hospital environment according to the paediatric decannulation protocol, which guarantees success and safety. The purpose of the study was to analyse the factors influencing decannulation in tracheotomised children and to present the decannulation protocol used at the Department for Otorhinolaryngology and Cervicofacial Surgery of the University Clinical Centre Ljubljana. Methods: Data on tracheotomies and decannulations (age at tracheotomy, indication for tracheotomy, associated diseases, complications of tracheotomy, date of decannulation, and surgical closure of tracheostomy) were retrospectively collected from 43 tracheotomised children. Results: 53.5% (23/43) of children were successfully decannulated (median age = 729.5 days) at a median time of 259.0 days from the tracheotomy. Dysphagia with aspiration was statistically significantly more common among non-decannulated children (p = 0.016) than decannulated children. In the group of decannulated children, the time to decannulation was longer in those under one year of age at the time of tracheotomy (p < 0.001), in those with comorbidities of the lower respiratory tract (p = 0.001 ) or prematurity (p = 0.005). The factor that statistically significantly increased time to decannulation was age at tracheotomy of one year or less (p < 0.001). Conclusion: The paediatric decannulation protocol ensures the successful and safe removal of TC. Dysphagia with aspiration is a common reason for preventing decannulation in children. Risk factors for an increased time to decannulation are age less than one year at tracheotomy, associated lower respiratory tract disease, and prematurity.