Accidental Tracheostomy Decannulations in Children—A Prospective Cohort Study of Inpatients

Erin M. Wynings, Nathaniel Breslin, Rebecca L. Brooks, Ashley F. Brown, Candice H. Bailey, Cindy Whitney, Yann Fuu Kou, Romaine F. Johnson, Stephen R. Chorney

Research output: Contribution to journalArticlepeer-review


Objectives: To determine the incidence of tracheostomy accidental decannulations (AD) among pediatric inpatients and identify risks for these events. Study Design: Prospective cohort. Methods: All tracheostomy patients (≤18 years) admitted at a tertiary children's hospital between August 2018 and April 2021 were included. AD were recorded and patient harm was classified as no harm/minor, moderate, or severe. Monthly AD incidence was described as events per 1000 tracheostomy-days. Results: One-hundred seventeen AD occurred among 67 children with 33% (22/67) experiencing multiple events (median: 2.5 events, range: 2–10). Mean age at AD was 4.7 years (SD: 4.4). AD resulted from patient movement (32%, 37/117), performing tracheostomy care (27%, 31/117), repositioning or transporting (15%, 17/117), or unclear reasons (27%, 32/117). A parent or guardian was involved in 28% (33/117) of events. Nearly all AD resulted in no more than minor harm (84%, 98/117) but moderate (12%, 14/117) and severe (4%, 5/117) events did occur. There were no deaths. Tracheostomy care or repositioning were frequently responsible in acute versus subacute events (48% vs. 26%, p = 0.04). Mean monthly AD incidence was 4.7 events per 1000 tracheostomy-days (95% CI: 3.7–5.8) and after implementation of safety initiatives, the mean rate decreased from 5.9 events (95% CI: 4.2–7.7) to 3.7 events (95% CI: 2.5–5.0) per 1000 tracheostomy-days (p = 0.04). Conclusions: AD in children occur at nearly 5 events per 1000 tracheostomy-days and often result in minimal harm. Quality initiatives targeting patient movement, provider education, and tracheostomy care might reduce the frequency of these complications. Level of Evidence: 3 Laryngoscope, 133:963–969, 2023.

Original languageEnglish (US)
Pages (from-to)963-969
Number of pages7
Issue number4
StatePublished - Apr 2023


  • accidental decannulation
  • pediatric tracheostomy
  • tracheostomy complications

ASJC Scopus subject areas

  • Otorhinolaryngology


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