The role of polysomnography in decannulation of children with brain and spinal cord injuries
| Autor: | David E. Tunkel, Amanda K. Morrow, Sharon A. McGrath-Morrow, Suzanne Rybczynski, Janet Lam, Joseph M. Collaco, Jennifer Accardo |
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| Rok vydání: | 2018 |
| Předmět: |
Adult
Male Pulmonary and Respiratory Medicine medicine.medical_specialty Adolescent Hospital setting Polysomnography Article Young Adult 03 medical and health sciences Tracheostomy 0302 clinical medicine medicine Cannula Humans Sleep study Child 030223 otorhinolaryngology Spinal Cord Injuries Retrospective Studies medicine.diagnostic_test business.industry medicine.disease Spinal cord Patient Discharge respiratory tract diseases medicine.anatomical_structure 030228 respiratory system Otorhinolaryngology Brain Injuries Child Preschool Anesthesia Pediatrics Perinatology and Child Health Airway Extubation Obstructive Apnea Female business Hypopnea Inpatient rehabilitation |
| Zdroj: | Pediatric Pulmonology. 54:333-341 |
| ISSN: | 1099-0496 8755-6863 |
| Popis: | Objective The objective of this retrospective review was to determine the utility of polysomnography (PSG) in influencing the decision to decannulate pediatric patients with brain and spinal cord injuries in an inpatient rehabilitation hospital setting. Methods Between 2010 and 2016, data were collected on pediatric patients with brain and/or spinal cord injuries who had PSG performed with the goal of decannulation. Patients underwent a decannulation protocol involving toleration of continuous tracheostomy capping and bedside tracheoscopy by otolaryngology. Decision to decannulate was determined with input from multiple disciplines. Associations were examined between decannulation success and findings on PSG as well as demographic factors, injury characteristics, otolaryngology findings, and timeline from initial injury to selected events. Results A total of 46 patients underwent PSG, after which 38 (83%) were deemed appropriate and eight (17%) were deemed inappropriate for decannulation. Individuals who were deemed ready for decannulation had significantly lower obstructive apnea hypopnea indexes (AHI) (1.7 vs 5.4 events/h, P = 0.03), respiratory disturbance indexes (RDI) (2.4 vs 7.6 events/h, P = 0.006), and peak end tidal carbon dioxide (CO2 ) levels (50.0 vs 58.7 torr, P = 0.009) on PSG compared to those who were not decannulated. There were no complications following decannulation prior to discharge. Conclusion PSG provided important additional information as part of a multidisciplinary team assessment of clinical readiness for decannulation in pediatric patients with brain and spinal cord injuries who underwent a decannulation protocol. Obstructive AHI, RDI, and peak end tidal CO2 level were associated with successful decannulation prior to discharge from inpatient rehabilitation. |
| Databáze: | OpenAIRE |
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