Is tracheotomy decannulation possible in oxygen-dependent children?

OBJECTIVE: The goal was to determine whether decannulation can be safely ac hieved in children with persistent oxygen requirements. DESIGN: The study was a prospective evaluation of 12 oxygen-dependent child ren at a tertiary care academic children's medical center. METHODS: Twelve tracheotomy-dependent children with persistent oxygen requi rements were evaluated for decannulation. Patients requiring more than 35% FiO(2) were not considered. Direct laryngoscopy and bronchoscopy were perfo rmed in all patients. Two required single-stage laryngotracheoplasty to cor rect subglottic stenosis, 1 required tracheal resection, and 7 required rem oval of suprastomal granulation tissue. Oxygen was administered offer decan nulation through a nasal cannula. RESULTS: Decannulation was successful in 92% (11 of 12) of patients. At fin al follow-up, oxygen requirements decreased in 58% of patients after decann ulation. CONCLUSIONS: Decannulation can be successful in children who remain oxygen dependent; conversion to a more physiologic airway may be an adjunct to red ucing or eliminating their oxygen demand.