Tracheostomy ‘decannulation panic’ in children: fact or fiction?

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Abstract
The phenomenon of tracheostomy 'decannulation panic' is likely to occur in children but probably is not psychologically based. The relatively small airway, local reflexes and changes in airway resistance seem sufficient to explain it on a mechanical basis. Because there were delays and failures in this series despite an apparently adequate airway, it is recommended that decannulation be performed on a controlled and gradual basis. The method of blocking a fenestrated tracheostomy tube provides a margin of safety. Chest physiotherapy, humidification and mucolytic agents will assist in preventing the acquisition of chest infection. Prophylactic antibiotics and steroids, however, do not appear to be of value and may actually be harmful.

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