Faculty Collaboration Database

Polysomnography Provides Useful Clinical Information in the Liberation from Respiratory Technology: A Retrospective Review. Pediatr Pulmonol 2018 Nov;53(11):1549-1558

Date

10/24/2018

Pubmed ID

30350930

DOI

10.1002/ppul.24164

Scopus ID

2-s2.0-85055179526 (requires institutional sign-in at Scopus site)   8 Citations

Abstract

Background The prevalence of respiratory-technology dependent children is increasing although for most children the goal is liberation from technology. Liberation from home mechanical ventilation (HMV) and decannulation strategies vary due to the lack of clinical practice standards. The primary objective of this study was to describe our practice utilizing a polysomnography (PSG) in the liberation from respiratory-technology process. Methods Retrospective study of tracheostomized children with and without HMV who underwent an evaluation for decannulation between January 2006 and June 2016. Patient demographics, indication for tracheostomy, indication for PSG, PSG results and interventions performed after the PSG were collected. RESULTS: We identified 153 decannulation attempts in 148 children. Ninety-nine children had a tracheostomy only and 49 children had a tracheostomy with HMV. There were 190 PSGs performed. Almost two-thirds of the children (N = 92) had at least one PSG, 37 children (25%) had two and 19 children (13%) had more than 2 PSGs. Children with tracheostomy and HMV had more PSGs compared to children with tracheostomy only. PSGs were performed at four points: (1) prior to tracheostomy placement (N = 23); (2) to titrate HMV (N = 19); (3) off-HMV support (N = 43); and with a capped tracheostomy (N = 101). Most of the off-HMV PSGs (N = 39) were favorable for discontinuing HMV. About two-thirds of the capped PSGs (N = 73) were favorable for decannulation; of the unfavorable capped PSGs (N = 28), thirteen required airway surgeries following the unfavorable PSG. CONCLUSION: : Overnight PSG provides useful information to the liberation process, particularly when determining readiness for discontinuing HMV and decannulation.

Author List

Bashir A, Henningfeld JK, Thompson NE, D'Andrea LA

Authors

Lynn A. D Andrea MD Chief, Professor in the Pediatrics department at Medical College of Wisconsin
Jennifer Henningfeld MD Associate Professor in the Pediatrics department at Medical College of Wisconsin
Nathan Thompson MD Associate Professor in the Pediatrics department at Medical College of Wisconsin

MESH terms used to index this publication - Major topics in bold

Airway Extubation
Child, Preschool
Device Removal
Female
Humans
Infant
Male
Polysomnography
Respiration, Artificial
Retrospective Studies
Tracheostomy