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January 1965

Method for Difficult Decannulations in Children

Author Affiliations

Presented at the Meeting of the Montreal Medico-Chirurgical Society, Section of Otolaryngology, Feb 19, 1964.; From the Departments of Otolaryngology and Anaesthesia, The Montreal Children's Hospital and McGill University.

Arch Otolaryngol. 1965;81(1):72-76. doi:10.1001/archotol.1965.00750050077016

Decannulation difficulties in prolonged tracheostomized children are well known to those with experience on a large pediatric service. Not infrequently a long and costly hospitalization results from the repeated failure to extubate a small child following a tracheostomy. This phenomenon has been well documented in the literature, the problem having been extensively outlined by numerous workers.1-16 Over the past ten years several patients have spent from 6 to 24 months in The Montreal Children's Hospital and have been subject to many hazardous procedures and complications because of this problem.

The Problem  The problem essentially follows an apparently straightforward tracheostomy, done for any of the usual indications, with an uneventful postoperative course. Difficulties first arise when an attempt is made to extubate the child anywhere from 4-14 daysafter tracheostomy. Removal of the tracheostomy tube in problem cases invariably results in gross upper respiratory obstruction necessitating recannulation, usually within 24

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