Factors Associated with Decannulation in Pediatrics

Backround Our aim was to identify the factors that increase the likelihood of successful decannulation in children with tracheotomies, in order to develop corrective strategies that improve decannulation possibility. Methods A single-center retrospective study was conducted, based on the medical records of children with tracheotomies between 2012 and 2019. This study compared the differences between children who were successfully decannulated and those for whom decannulation was not attempted. Results Out of 171 children with tracheostomy, 59 (34.5%) successfully underwent decannulation by 2019. The mean tracheostomy duration was 46.7(±3.1) months for those with ongoing tracheostomy and 17.6(±1.8) months for decannulated children. Neurological disorders were more common in non-decannulated children, while congenital heart disease and airway abnormalities were more prevalent in decannulated children. Factors associated with lower decannulation rates were the presence of the colonization (2.4-fold) and a history of post-tracheostomy home ventilation support (2.6-fold). About 33% of the children had colonization, with higher rates observed in those requiring home ventilation support post-tracheostomy placement (p<0.001), children with feeding/swallowing disorders (p=0.005), and neurological disorders (p=0.002). Only the presence of a feeding and swallowing disorder (2.6-fold) was independently associated with colonization, irrespective of the duration of tracheostomy. Conclusion Colonization may reduce the likelihood of successful decannulation. Clinicians may consider monitoring children with feeding/swallowing disorders and the chronic airway colonization. Additionally, providing caregiver education on infection control measures to prevent lower airway colonization could be beneficial.