The role of polysomnography in decannulation of children with brain and spinal cord injuries

Pediatr Pulmonol., 2019 · DOI: 10.1002/ppul.24208 · Published: March 1, 2019

Sleep Medicine Pediatrics Rehabilitation

Simple Explanation

Children with brain and spinal cord injuries often need a tracheostomy for breathing support. Removing this tube, called decannulation, is a key goal in their recovery. Polysomnography (PSG), or sleep study, can help determine if a child is ready to have the tracheostomy removed. It assesses breathing patterns during sleep, when breathing muscles are more relaxed. This study looks at how PSG influenced the decision to remove tracheostomies in children with brain and spinal cord injuries undergoing rehabilitation.

Study Duration

2010 to 2016

Participants

46 pediatric patients with brain and/or spinal cord injuries

Evidence Level

Level 3: Retrospective Review

Key Findings

1
Lower obstructive apnea hypopnea index (AHI), respiratory disturbance index (RDI), and peak end tidal carbon dioxide (CO2) levels on PSG were associated with successful decannulation.
2
The presence of suprastomal granuloma discovered on airway endoscopy was associated with a decision not to decannulate.
3
PSG provided valuable information in determining readiness for decannulation in patients undergoing inpatient rehabilitation.

Research Summary

This retrospective review aimed to determine the utility of polysomnography (PSG) in influencing the decision to decannulate pediatric patients with brain and spinal cord injuries. The study found that lower obstructive AHI, RDI and peak end tidal CO2 levels on PSG were associated with successful decannulation. The study concludes that PSG provides important additional information as part of a multidisciplinary team assessment of clinical readiness for decannulation.

Practical Implications

Improved Decannulation Decisions

PSG can help clinicians make better-informed decisions about when to decannulate children with brain and spinal cord injuries, potentially reducing complications.

Multidisciplinary Approach

The study highlights the importance of a multidisciplinary team, including pulmonologists, otolaryngologists, sleep medicine specialists, and speech language pathologists, in the decannulation process.

Airway Endoscopy Importance

Airway endoscopy should be performed to evaluate and treat any structural abnormalities before assessing dynamic airway factors.

Study Limitations

1
Retrospective single center study
2
Small sample size in the no decannulation group
3
Physicians scoring the sleep studies were not blinded to the team’s clinical assessment

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