Included studies
Characteristics detailed in the included studies are shown in table 1.
All the included studies are descriptive (17
retrospective(15)(18-20)(22-34), 1
prospective(35) and 4 series of
cases.(36-39)
The studies were all in a single center. Most of the studies were from
the USA (United States of America), (14) (18-19) (23)
(26) (28) (30) (32-35) (37) 6 from Europe, (21- 22)
(24-25) (31) (38) 2 from India, (29) (36) and 1 from
Australia.
The total amount of patients in the studies was 1222, the age range
between 0 and 21 years old. The most frequent underlying disease was
acquired or congenital airway alteration, and chronic pulmonary
disease.(22) (24-27) (29) (31) (33-36) (38-39) Few
studies informed the severity of the disease in the included
patients.(19) (22) (24-26) (31-33) (39)
None of the studies informed if the tracheostomy was performed by
percutane or surgical technique. The indication of tracheostomy was
informed on 76% of studies, most of the times by alterations in facial
and upper airways.(17) (22-26) (31) (33) (39).
The duration of the mechanical ventilation support (MVS) was only
measured in one study (around 19 days).(30) Even
though the inclusion criteria were well-detailed in 15 studies(14) (18-19) (22) (24-30) (35-38) the exclusion
criteria were only mentioned in 9 (14) (18-19) (29)
(31) (33) (36-38). Decannulation protocols or algorithms were used in
all studies with the exception of one.(34)Polysomnography (PSM) took place in half the studies(17-19) (25-28) (31) (33-34) (37) and only when
\soutin was necessary in 3.(24) (29) (35)Radiography test was only mentioned in 2 protocols(30)
(37) and endoscopy in most of them. In 9 studies(14)
(17) (23-24) (27-28) (33) (35) (37) the indication to start the
decannulation protocol was that patients were clinically stable and in 5
of them that the cause of tracheotomy was resolved.(22)
(28) (30) (33) (35) In 11 studies(17) (23-26) (28-29)
(33-34) (37) (39) the decrease of the cannula diameter was the prior
step to the its occlusion which was done in 14
studies.(19) (22-24) (26) (28-33) (36) (38-39) Only in
three studies the cannula was changed, mostly for smaller
cannulas.(22) (36) (38) Only at the beginning of two
protocols there was an education plan for parents and intervening
professionals.(30) (38) Decannulation criteria were
presented in almost all the studies - 19 studies - from which clinical
and monitoring parameters such as partial oxygen saturation (spo2) were
selected by the majority as measures defining or non-defining
decannulation. PSG was chosen by 8(17-19) (27-28) (31)
(33) (37),cough effectivity only in 3 studies(24)
(32-33) and endoscopy in 4.(14) (31-33)
Non-invasive ventilation (NIV) was used in 4 studies but after
decannulation as a rescue maneuver.(25) (28-29) (34)The main outcome, in this case a successful decannulation, was only
defined in 4 studies(18) (27) (35) (38) in two out of
which the success was defined by the patient sustaining a stable
decannulation for 6 months(27) (35) and in the other 2
studies for 2 years(18) or till the end of the
tracing.(38) The post-decannulation observation period
varied greatly among studies. The majority from 3 hours to 5
days(14) (17) (19) (23-24) (29) (31) (36) (39) or 3 to
6 months. (25) (27) (35)
Decannulation success ratio was over 70% in most studies - between 70
and 100% by protocol and in the first attempt - . As to PSG various
authors concluded that in could be a good success predictor or, no less
important, a parameter that could aid in decision making process when
undertaking a decannulation.(17-19) (27-28) (33) (37)As to protocols usage it is mentioned in only two studies that it may
aid to avoid a failure in decannulation but there are not any
conclusions due to the nature of the designs.
Each study description is presented on the chart of included studies
(chart 2).