B62-11 Streamlining the Path to Decannulation: Trends and Opportunities in Pediatric Tracheostomy Care

Abstract Background Decannulation is a critical step in recovery for children requiring prolonged mechanical ventilation or management of upper airway obstruction (UAO). Determining readiness for decannulation involves multiple steps, yet the order and timing of evaluations are not standardized. The American Thoracic Society recommends a multidisciplinary approach with airway evaluations and capped sleep studies, leaving timing and sequence to individual practitioners. This study evaluates the decannulation pathway at Children's Wisconsin, identifies factors associated with timing, and highlights opportunities to streamline care. Methods We conducted a retrospective chart review of children who underwent tracheostomy decannulations at Children’s Wisconsin from 2019-2025. Data collected included patient demographics, comorbidities, primary tracheostomy indication, pre-decannulation evaluations categorized into either endoscopy, endoscopy+procedure, procedure, or capped sleep study, and timing between key decannulation pathway steps. External medical records were excluded. Results were analyzed using R studio. Results Sixty-seven children met inclusion criteria (55.7% male). Median age at tracheostomy placement was 148 days (range 1-6502). Indications included facilitation of ventilation (n = 45, 67%) and UAO (n = 22, 33%). Capping trials occurred in 87% (n = 58) with an average of 354 days from capping to decannulation. Time to decannulation (TTD) after capping was significantly shorter for UAO than for ventilation (207 vs 414 days, p = 0.02). After capping, children with UAO averaged fewer evaluations than ventilation patients (1.32 vs 3.02, p = 0.001). Children requiring fewer evaluations decannulated faster (0 evaluations: 3.2 days, 1-2 evaluations: 254 days, 3-4 evaluations: 479 days, 5 evaluations: 892 days). After capping, the most common first evaluation for children with UAO was capped sleep study (n = 10, 46%) whereas ventilated patients equally underwent capped sleep study or endoscopy (n = 12, 27%). Final evaluations for UAO were most commonly endoscopy (63%) while for ventilation it was endoscopy+procedure (34%). 62.7% (n = 42) received sleep studies. Decannulation pathways for both groups varied widely in order and timing of evaluations (Figure 1). There was no statistically significant association between the first (p = 0.429) or last (p = 0.123) evaluation type and TTD. Conclusion Pediatric decannulation pathways vary by indication and evaluation frequency. Children with UAO decannulated more quickly after capping. Differences in TTD likely reflect disease-specific factors: UAO is often surgically corrected, whereas ventilator dependence requires gradual physiologic maturation. Fewer evaluations were associated with shorter TTD, highlighting opportunities to streamline sequencing and reduce delays. Wide variability in evaluation reflects both diverse disease processes and practice patterns, underscoring the need for standardized pathways to improve efficiency and patient outcomes. This abstract is funded by: None