Decannulation of Tracheostomy Tubes in Children and the Role of Polysomnogram in Predicting the Presence of Sleep Apnea
| dc.contributor.advisor | Samuel, Susan | |
| dc.contributor.author | Platt, Jody Marie | |
| dc.contributor.committeemember | Adeleye, Adetayo | |
| dc.contributor.committeemember | Pendharkar, Sachin | |
| dc.contributor.committeemember | Hagel, Brent | |
| dc.date | 2024-11 | |
| dc.date.accessioned | 2024-07-09T17:32:37Z | |
| dc.date.available | 2024-07-09T17:32:37Z | |
| dc.date.issued | 2024-07-05 | |
| dc.description.abstract | Tracheostomy tubes in children with complex respiratory conditions may eventually be removed. There is variation in practice among pediatric care teams including the use of polysomnography (PSG). This work reviewed global practices of tracheostomy decannulation and described local practice and outcomes. A scoping review was completed using PRISMA guidelines. Data were extracted from 52 articles and fit to the Donabedian Framework for quality assessment including: structure, process and outcome. Decannulations were done at tertiary care centers (51/52, 98%), but articles often lacked information about health care structure like multi-disciplinary care (only 4/52, 8% with information). Airway endoscopy was the most common investigation before decannulation (43/52, 83%) and PSG testing was reported as completed (27/52, 52%) in half of the studies. When Pulmonary physicians were involved, PSG was commonly included (14/23, 61%). Outcomes focused on decannulation success (43/52, 83%), and success was higher when PSG was done. While different approaches exist, common themes emerged. Original tracheostomy indication and the subspecialties of doctors involved may impact decannulation process including PSG use and outcomes considered. A descriptive study was performed using the database from the Complex Airway Clinic (CAC) in Calgary, Alberta and supplemented with electronic medical record data. The approach to decannulation was described and fifty-two children were identified with upper airway obstruction (UAO) (18/52, 35%), upper airway obstruction and craniofacial syndrome (UAO/SYN) (13/52, 25%), long-term ventilation (LTV) (12/52, 23%), and temporary (TEMP) (9/52, 17%). Details of structure, process and outcomes per the Donabedian Framework were abstracted from the medical records. Children attended the multi-disciplinary CAC and most children without a TEMP tracheostomy tube attended the Otolaryngology / Respirology Combined Clinic for decannulation planning (39/43, 91%). Most children without a temporary tracheostomy had a functional airway assessment (FAA) (31/43, 72%). Children with UAO/SYN (7/13, 54%) and LTV (7/12, 58%) had a PSG before decannulation. Decannulation was successful for 51 of 52 children (98%). There were 7 children with a completed PSG before and after decannulation and there was a moderate agreement (k=0.46) observed in obstructive sleep apnea severity between the studies. Further studies with a prospective multi-center design are required to determine the usefulness of pre-decannulation PSG to inform risk of tracheostomy decannulation including residual obstructive sleep apnea. The indication for tracheostomy tube insertion may help to determine the optimal approach to tracheostomy decannulation and protocol development. | |
| dc.identifier.citation | Platt, J. M. (2024). Decannulation of tracheostomy tubes in children and the role of polysomnogram in predicting the presence of sleep apnea (Master's thesis, University of Calgary, Calgary, Canada). Retrieved from https://prism.ucalgary.ca. | |
| dc.identifier.uri | https://hdl.handle.net/1880/119138 | |
| dc.language.iso | en | |
| dc.publisher.faculty | Graduate Studies | |
| dc.publisher.institution | University of Calgary | |
| dc.rights | University of Calgary graduate students retain copyright ownership and moral rights for their thesis. You may use this material in any way that is permitted by the Copyright Act or through licensing that has been assigned to the document. For uses that are not allowable under copyright legislation or licensing, you are required to seek permission. | |
| dc.subject | Pediatrics | |
| dc.subject | Tracheostomy | |
| dc.subject | Decannulation | |
| dc.subject | Polysomnography | |
| dc.subject.classification | Medicine and Surgery | |
| dc.title | Decannulation of Tracheostomy Tubes in Children and the Role of Polysomnogram in Predicting the Presence of Sleep Apnea | |
| dc.type | master thesis | |
| thesis.degree.discipline | Medicine – Community Health Sciences | |
| thesis.degree.grantor | University of Calgary | |
| thesis.degree.name | Master of Science (MSc) | |
| ucalgary.thesis.accesssetbystudent | I do not require a thesis withhold – my thesis will have open access and can be viewed and downloaded publicly as soon as possible. |