SUPRASTOMAL GRANULATION-TISSUE AND PEDIATRIC TRACHEOTOMY DECANNULATION

Although numerous decannulation techniques have been reported, often i nvolving costly sleep studies, repetitive laser procedures, and trache otomy tube ''downsizing,'' no established standard of care exists. We advocate the following simple, minimally invasive decannulation protoc ol. After excluding concomitant airway lesions, suprastomal granulatio n is removed transtomally by an endoscopically guided rongeur. A trach eotomy tube is then fashioned with a fenestration centered in the trac heal lumen. Decannulation occurs if the patient maintains adequate ven tilation over a 12- to 24-hour observation period with the fenestrated tracheotomy capped, Over 18 months we prospectively followed 10 conse cutive children presenting as potential decannulation candidates. Usin g the aforementioned technique, nine of 10 patients were successfully decannulated (average follow-up, 11.5 months). The postoperative cappe d fenestrated tracheotomy trial provides a realistic assessment of pre paredness for decannulation. We recommend this protocol as a rapid, ef ficient, and cost-effective means of achieving decannulation.