Management of Difficult Decannulation .
- Author:
Tai Ho CHUNG
1
;
Woon Hyok CHUNG
Author Information
1. Department of Anesthesiology, Catholic Medical College, Seoul, Korea.
- Publication Type:Case Report
- MeSH:
Adult;
Airway Obstruction;
Catheters;
Child;
Child, Preschool;
Edema;
Female;
Humans;
Critical Care;
Intubation;
Patient Care;
Stents;
Tracheal Stenosis;
Tracheostomy;
Tracheotomy
- From:Korean Journal of Anesthesiology
1975;8(2):127-130
- CountryRepublic of Korea
- Language:Korean
-
Abstract:
Tracheostomy is done to treat the acute upper airway obstruction. But when the condition. precipitating tracheotomy has resolved, the tracheal cannula cannot be removed sometimes because of the anatomical change at the tracheotomised tissue. This is described that decannulation is delayed. Delayed decannulation is uncommon but occurs more frequently in young children than in adults. The child who is difficult to decannulate is continuously at risk. His family experiences emotional, social and sometimes economic hardships. Many factors may delay decannulation; a frequent cause is posterior displacement of the: anterior tracheal well above the tracheotomy stoma induced by the position and pressure of the tracheotomy cannula itself. High tracheotomy, subglottic edema, emotional dependence increase of upper air-way resistance and delayed laryngeal development are solo the factors. One of the treatment of the difficult decannulation, T-tube stent was inserted through tracheoplasty. in this report, a 24 months old girl, nasotracheal intubation was used in the attempted decannulation. Radiological and endoscopic evaluation indicated that posterior displacement of the anterior tracheal well above the tracheal stoma was the cause of the delay. Dacalnnulation was achieved after 10 days of the intubation therapy. Etiology of the tracheal stenosis, pattern of respiratory difficulty, technic and patient care of nasotracheal intubation as the therapy of delayed decannulation and the role of anesthesiologists and pediatric intensive care was discussed.
