Conclusion
Amongst the most frequent indications are prolonged mechanical ventilation and, to a lesser extent, upper airways obstruction.
Tracheostomy implies such a morbidity and mortality rate, that makes it necessary to plan decannulation from the very first moments of its performance.
According to international literature, mechanical ventilation independence from 3 to 4 previous months and the lack of secretions are considered criteria to suggest decannulation.
In order to evaluate the anatomy of the airway prior to decannulation, laryngoscopy and fibrobronchoscopy are preferred.
There is no consensus amongst the authors regarding the use of the test of occlusion on the tracheostomy cannula, but they agree that polysomnography is a complementary method to fibroscopy which may be related to decannulation success prediction.
The lack of proven variabilities which can be used during the decannulation process makes it difficult to provide specific recommendations for decannulation protocols. More level II studies are needed in order to evaluate its effectiveness.
On the other hand, something that should be also taken into account in the current context of health care is that an ideal protocol should present an efficient use of resources without compromising the patient’s safety, optimizing the cost.(4) So, the question is: Which is the most safe and effective way to do the decannulation procedure?
To answer this, the health team professionals must study/test/evaluate the safety and effectiveness of their methods. The risk of acute failures must be minimized since they may/can lead to a catastrophic impact over the patient’s mobility. Another aspect which needs to be taken into account is the availability and use of resources, material and human,so the accessible, and proper quality assistance can be guaranteed.
Decannulation is the final goal shared by the patient the family and the health team who assist children with chronic tracheostomy. Most pediatric patients can hope for an effective solution to their underlying airway pathology tolerating decannulation.
The current systematic review will allow the subsequent development and study of a decannulation protocol for pediatric patients, as well as identify the theoretical elements which would have a positive impact on the training of the healthcare workers in charge of the tracheostomized patient assistance.
Furthermore, the implementation of a protocol may lead to a substantial modification in the duration of the hospitalization, as well as represent an opportunity to make a more efficient use of resources.