1. Realizar avaliação endoscópica da anatomia e funcionalidade das vias aéreas, para confirmar a patência adequada em todos os níveis, e excluir ou tratar complicações. |
Avelino et al.(22 Avelino MAG, Maunsell R, Valera FCP, Lubianca Neto JF, Schweiger C, Miura CS, et al. First Clinical Consensus and National Recommendations on Tracheostomized Children of the Brazilian Academy of Pediatric Otorhinolaryngology (ABOPe) and Brazilian Society of Pediatrics (SBP). Rev Bras Otorrinolaringol (Engl Ed). 2017;83(5):498-506. PMid:28807655.), 2017; |
Nível de evidência: 2b, 4 e 5 |
Benjamin e Curley(2323 Benjamin B, Curley JWA. Infant tracheotomy - endoscopy and decannulation. Int J Pediatr Otorhinolaryngol. 1990;20(2):113-21. http://dx.doi.org/10.1016/0165-5876(90)90076-4. PMid:2286504. http://dx.doi.org/10.1016/0165-5876(90)9...
), 1990; Canning et al. (77 Canning J, Mills N, Mahadevan M. Pediatric tracheostomy decannulation: when can decannulation be performed safely outside of the intensive care setting? A 10 year review from a single tertiary otolaryngology service. Int J Pediatr Otorhinolaryngol. 2020;133:109986. http://dx.doi.org/10.1016/j.ijporl.2020.109986. PMid:32199340. http://dx.doi.org/10.1016/j.ijporl.2020....
), 2020; |
Grau de recomendação: B, C e D |
Kennedy et al. (2424 Kennedy A, Hart CK, de Alarcon A, Balakrishnan K, Boudewyns A, Chun R, et al. International Journal of Pediatric Otorhinolaryngology International Pediatric Otolaryngology Group (IPOG) management recommendations : pediatric tracheostomy decannulation. Int J Pediatr Otorhinolaryngol. 2021;141:110565. http://dx.doi.org/10.1016/j.ijporl.2020.110565. PMid:33341719. http://dx.doi.org/10.1016/j.ijporl.2020....
), 2021. |
Risco de viés: baixo a moderado |
2. Promover oclusão/tamponamento da cânula de traqueostomia de modo progressivo, se via aérea patente. |
Avelino et al.(22 Avelino MAG, Maunsell R, Valera FCP, Lubianca Neto JF, Schweiger C, Miura CS, et al. First Clinical Consensus and National Recommendations on Tracheostomized Children of the Brazilian Academy of Pediatric Otorhinolaryngology (ABOPe) and Brazilian Society of Pediatrics (SBP). Rev Bras Otorrinolaringol (Engl Ed). 2017;83(5):498-506. PMid:28807655.), 2017; |
Nível de evidência: 2b, 4 e 5 |
Kennedy et al. (2424 Kennedy A, Hart CK, de Alarcon A, Balakrishnan K, Boudewyns A, Chun R, et al. International Journal of Pediatric Otorhinolaryngology International Pediatric Otolaryngology Group (IPOG) management recommendations : pediatric tracheostomy decannulation. Int J Pediatr Otorhinolaryngol. 2021;141:110565. http://dx.doi.org/10.1016/j.ijporl.2020.110565. PMid:33341719. http://dx.doi.org/10.1016/j.ijporl.2020....
), 2021 |
Grau de recomendação: B, C e D |
Maslan et al.(66 Maslan JT, Feehs KR, Kirse DJ. Considerations for the successful decannulation of the pediatric patient: A single surgeon’s experience. Int J Pediatr Otorhinolaryngol. 2017;98:116-20. http://dx.doi.org/10.1016/j.ijporl.2017.04.038. PMid:28583487. http://dx.doi.org/10.1016/j.ijporl.2017....
), 2017; Mitchell et al.(1212 Mitchell RB, Hussey HM, Setzen G, Jacobs IN, Nussenbaum B, Dawson C, et al. Clinical consensus statement: tracheostomy care. Otolaryngol Head Neck Surg. 2013;148(1):6-20. http://dx.doi.org/10.1177/0194599812460376. PMid:22990518. http://dx.doi.org/10.1177/01945998124603...
), 2013; |
Risco de viés: baixo, moderado e alto |
Pozzi et al.(99 Pozzi M, Galbiati S, Locatelli F, Clementi E, Strazzer S. Performance of a tracheostomy removal protocol for pediatric patients in rehabilitation after acquired brain injury: factors associated with timing and possibility of decannulation. Pediatr Pulmonol. 2017;52(11):1509-17. http://dx.doi.org/10.1002/ppul.23832. PMid:28950420. http://dx.doi.org/10.1002/ppul.23832...
), 2017. |
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3. Utilizar a oximetria de pulso para monitoramento de sinais de desconforto respiratório e dessaturações em internação hospitalar durante o processo de decanulação. |
Canning et al.(77 Canning J, Mills N, Mahadevan M. Pediatric tracheostomy decannulation: when can decannulation be performed safely outside of the intensive care setting? A 10 year review from a single tertiary otolaryngology service. Int J Pediatr Otorhinolaryngol. 2020;133:109986. http://dx.doi.org/10.1016/j.ijporl.2020.109986. PMid:32199340. http://dx.doi.org/10.1016/j.ijporl.2020....
), 2020; |
Nível de evidência: 2b e 4 |
Pozzi et al.(99 Pozzi M, Galbiati S, Locatelli F, Clementi E, Strazzer S. Performance of a tracheostomy removal protocol for pediatric patients in rehabilitation after acquired brain injury: factors associated with timing and possibility of decannulation. Pediatr Pulmonol. 2017;52(11):1509-17. http://dx.doi.org/10.1002/ppul.23832. PMid:28950420. http://dx.doi.org/10.1002/ppul.23832...
), 2017; |
Grau de recomendação: B e C |
Seligman et al.(2121 Seligman KL, Liming BJ, Smith RJH. Pediatric tracheostomy decannulation: 11-year experience. Otolaryngol Head Neck Surg. 2019;161(3):499-506. http://dx.doi.org/10.1177/0194599819842164. PMid:30987524. http://dx.doi.org/10.1177/01945998198421...
), 2019. |
Risco de viés: baixo a moderado |
|
|
4. Considerar exame de polissonografia para avaliar a funcionalidade da via aérea durante o sono, a depender da complexidade clínica e estrutural do paciente. |
Kennedy et al.(2424 Kennedy A, Hart CK, de Alarcon A, Balakrishnan K, Boudewyns A, Chun R, et al. International Journal of Pediatric Otorhinolaryngology International Pediatric Otolaryngology Group (IPOG) management recommendations : pediatric tracheostomy decannulation. Int J Pediatr Otorhinolaryngol. 2021;141:110565. http://dx.doi.org/10.1016/j.ijporl.2020.110565. PMid:33341719. http://dx.doi.org/10.1016/j.ijporl.2020....
), 2021; |
Nível de evidência: 2b e 5 |
Lee et al.(1313 Lee J, Soma MA, Teng AY, Thambipillay G, Waters KA, Cheng AT. The role of polysomnography in tracheostomy decannulation of the paediatric patient. Int J Pediatr Otorhinolaryngol. 2016;83(4):132-6. http://dx.doi.org/10.1016/j.ijporl.2016.01.034. PMid:26968066. http://dx.doi.org/10.1016/j.ijporl.2016....
), 2016. |
Grau de recomendação: B e D |
|
Risco de viés: baixo a moderado |
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5. Manter a criança em observação hospitalar por 24 horas após a decanulação. |
Kennedy et al.(2424 Kennedy A, Hart CK, de Alarcon A, Balakrishnan K, Boudewyns A, Chun R, et al. International Journal of Pediatric Otorhinolaryngology International Pediatric Otolaryngology Group (IPOG) management recommendations : pediatric tracheostomy decannulation. Int J Pediatr Otorhinolaryngol. 2021;141:110565. http://dx.doi.org/10.1016/j.ijporl.2020.110565. PMid:33341719. http://dx.doi.org/10.1016/j.ijporl.2020....
), 2021. |
Nível de evidência: 2b |
Maslan et al.(66 Maslan JT, Feehs KR, Kirse DJ. Considerations for the successful decannulation of the pediatric patient: A single surgeon’s experience. Int J Pediatr Otorhinolaryngol. 2017;98:116-20. http://dx.doi.org/10.1016/j.ijporl.2017.04.038. PMid:28583487. http://dx.doi.org/10.1016/j.ijporl.2017....
), 2017; |
Grau de recomendação: B |
Prickett e Sobol(2828 Prickett KK, Sobol SE. Inpatient observation for elective decannulation of pediatric patients with tracheostomy. JAMA Otolaryngol Head Neck Surg. 2015;141(2):120-5. http://dx.doi.org/10.1001/jamaoto.2014.3013. PMid:25429439. http://dx.doi.org/10.1001/jamaoto.2014.3...
), 2015. |
Risco de viés: baixo a moderado |
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