Infant Tracheotomy Decannulation Status Based on Indications for Procedure

by Linda Kossoff •

What factors account for differences in time to decannulation and survival rates for pediatric tracheotomy patients, based on ventilator status upon discharge?

Botton Line: For pediatric tracheotomy patients <3 years of age, the likelihood of and time to decannulation varies based on indication for the tracheostomy.

BACKGROUND: There are numerous indications for tracheostomy placement in patients <3 years of age that are not mutually exclusive. Previous studies on pediatric tracheostomy patients included older pediatric patients, resulting in more indications related to airway obstruction and trauma. Therefore, a study focused on consequences for younger tracheostomy patients is essential.

STUDY DESIGN: Retrospective longitudinal cohort study.

SETTING: Department of Otolaryngology, University of Texas Southwestern Medical Center, Dallas.

SYNOPSIS: Researchers conducted a retrospective single-institution database study of 305 patients who had a tracheostomy placed in infancy from 2009 to 2017. Patients were enrolled in the study at the time of tracheostomy and were followed until the primary endpoint (decannulation) was reached, they reached adulthood, or they died. The patients were divided into two groups based on their mechanical ventilation status at discharge. Primary reasons for tracheostomy included respiratory failure (70%), airway obstruction (48%), or pulmonary toilet (3.3%). The study demonstrated a significant difference in time to decannulation rates that favored patients discharged on a ventilator and an equal likelihood of survival regardless of ventilator status. Bronchopulmonary dysplasia, ventilator dependence, and airway obstruction had an increased likelihood of decannulation, indicating that decannulation status varies based on the tracheostomy indication. A majority of patients were not decannulated at study conclusion. Median time to decannulation was 2.5 years for patients with a median death time of six months. Data from the study can be utilized as a guide for long-term outcomes in infant populations. Limitations included the review’s retrospective single-institution nature and short-term follow-up for patients with more recent tracheostomies.

CITATION: Salley J, Kou YF, Shah GB, et al. Survival analysis and decannulation outcomes of infants with tracheotomies. Laryngoscope. 2020;130:2319-2324.