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.