<?xml version="1.0" encoding="ISO-8859-1"?><article xmlns:mml="http://www.w3.org/1998/Math/MathML" xmlns:xlink="http://www.w3.org/1999/xlink" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance">
<front>
<journal-meta>
<journal-id>2184-6499</journal-id>
<journal-title><![CDATA[Revista Portuguesa Otorrinolaringologia e Cirurgia de Cabeça e Pescoço]]></journal-title>
<abbrev-journal-title><![CDATA[Rev Port ORL]]></abbrev-journal-title>
<issn>2184-6499</issn>
<publisher>
<publisher-name><![CDATA[Sociedade Portuguesa de Otorrinolaringologia e Cirurgia de Cabeça e Pescoço]]></publisher-name>
</publisher>
</journal-meta>
<article-meta>
<article-id>S2184-64992023000400401</article-id>
<article-id pub-id-type="doi">10.34631/sporl.2058</article-id>
<title-group>
<article-title xml:lang="pt"><![CDATA[Protocolo de descanulação de traqueostomia num hospital pediátrico terciário]]></article-title>
<article-title xml:lang="en"><![CDATA[Tracheostomy decannulation protocol in a tertiary pediatric hospital]]></article-title>
</title-group>
<contrib-group>
<contrib contrib-type="author">
<name>
<surname><![CDATA[Chantre]]></surname>
<given-names><![CDATA[Tiago]]></given-names>
</name>
<xref ref-type="aff" rid="Aff"/>
</contrib>
<contrib contrib-type="author">
<name>
<surname><![CDATA[Moreira]]></surname>
<given-names><![CDATA[Inês Alpoim]]></given-names>
</name>
<xref ref-type="aff" rid="Aff"/>
</contrib>
<contrib contrib-type="author">
<name>
<surname><![CDATA[Barroso]]></surname>
<given-names><![CDATA[Mafalda]]></given-names>
</name>
<xref ref-type="aff" rid="Aff"/>
</contrib>
<contrib contrib-type="author">
<name>
<surname><![CDATA[Oliveira]]></surname>
<given-names><![CDATA[Mariana]]></given-names>
</name>
<xref ref-type="aff" rid="Aff"/>
</contrib>
<contrib contrib-type="author">
<name>
<surname><![CDATA[Sousa]]></surname>
<given-names><![CDATA[Herédio]]></given-names>
</name>
<xref ref-type="aff" rid="Aff"/>
</contrib>
</contrib-group>
<aff id="Af1">
<institution><![CDATA[,Centro Hospitalar Universitário Lisboa Central Serviço de Otorrinolaringologia ]]></institution>
<addr-line><![CDATA[ ]]></addr-line>
<country>Portugal</country>
</aff>
<pub-date pub-type="pub">
<day>00</day>
<month>12</month>
<year>2023</year>
</pub-date>
<pub-date pub-type="epub">
<day>00</day>
<month>12</month>
<year>2023</year>
</pub-date>
<volume>61</volume>
<numero>4</numero>
<fpage>401</fpage>
<lpage>412</lpage>
<copyright-statement/>
<copyright-year/>
<self-uri xlink:href="http://scielo.pt/scielo.php?script=sci_arttext&amp;pid=S2184-64992023000400401&amp;lng=en&amp;nrm=iso"></self-uri><self-uri xlink:href="http://scielo.pt/scielo.php?script=sci_abstract&amp;pid=S2184-64992023000400401&amp;lng=en&amp;nrm=iso"></self-uri><self-uri xlink:href="http://scielo.pt/scielo.php?script=sci_pdf&amp;pid=S2184-64992023000400401&amp;lng=en&amp;nrm=iso"></self-uri><abstract abstract-type="short" xml:lang="pt"><p><![CDATA[Resumo  Introdução  - A traqueostomia pediátrica está associada a uma significativa morbilidade, sendo a descanulação o objetivo primordial, assim que a indicação subjacente para o procedimento se encontre resolvida. Existe grande variabilidade nos protocolos de descanulação pediátrica, tornando-se imperativo a criação de um protocolo que espelhe a realidade dos hospitais portugueses.  Objetivos - Descrever o protocolo de descanulação do Hospital Dona Estefânia, destacando as etapas essenciais para a descanulação de doentes pediátricos com traqueostomias de longa duração. Discutir as observações preliminares sobre a segurança e eficácia deste protocolo.  Material e Métodos - Realização de uma revisão bibliográfica sistemática nas bases de dados MEDLINE, Cochrane Central Register of Controlled Trials and Cumulative Index to Nursing and Allied Health Literature, baseada no modelo PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses), selecionando trabalhos publicados entre janeiro de 2011 e dezembro de 2021. Com base nesta revisão foi construído o protocolo de descanulação do Hospital Dona Estefânia.  Resultados  - Um total de 22 estudos foram revistos, incluindo 2387 doentes. As modificações da cânula de traqueostomia incluíram a utilização de tampa (n = 18, 82%), redução de tamanho (n = 12, 55%) e utilização de cânula fenestrada (n = 1, 5%). As medições das trocas de gases respiratórios prévias à descanulação incluíram oximetria (n = 9, 41%), capnografia (n = 3, 14%), gasimetria (n = 2, 9%) e polissonografia (n = 14, 64%). A laringotraqueoscopia foi utilizada rotineiramente em 21 dos 22 (95.5%) protocolos. Após a descanulação, os doentes são transferidos para a enfermaria ou unidade de cuidados intensivos, ficando a maioria em ar ambiente e cumprindo um período de observação não superior a 48 horas (77% dos protocolos). No protocolo proposto para o HDE, a criança considerada apta a descanulação deve-se encontrar sem necessidade de suporte ventilatório, a tolerar a diminuição do tamanho da cânula de traqueostomia e a utilização de tampa, sem dessaturações ou sinais de dificuldade respiratória, diurnos, noturnos ou em exercício.  Conclusões  - Linhas orientadoras baseadas na evidência que padronizem os cuidados com a traqueostomia pediátrica e o processo de descanulação continuam a ser uma prioridade.]]></p></abstract>
<abstract abstract-type="short" xml:lang="en"><p><![CDATA[Abstract  Introduction Pediatric tracheostomy is associated with significant morbidity, with decannulation being the primary outcome, as soon as the underlying indication for the procedure is resolved. There is great variability in pediatric decannulation protocols, making it imperative to create a protocol that reflects the reality of Portuguese hospitals.  Objectives To describe the decannulation protocol at Hospital Dona Estefânia, highlighting the essential steps for the decannulation of pediatric patients with long-term tracheostomies. Discuss preliminary observations about the safety and efficacy of this protocol.  Material and Methods A systematic literature review was carried out in the MEDLINE, Cochrane Central Register of Controlled Trials and Cumulative Index to Nursing and Allied Health Literature databases, based on the PRISMA model (Preferred Reporting Items for Systematic Reviews and Meta-Analyses), selecting papers published between January 2011 and December 2021. Based on this review, the decannulation protocol at Hospital Dona Estefânia was constructed.  Results A total of 22 studies were reviewed, including 2387 patients. Modifications to the tracheostomy tube included the use of a cap (n = 18, 82%), size reduction (n = 12, 55%) and use of a fenestrated tube (n = 1, 5%). Measurements of respiratory gas exchange prior to decannulation included oximetry (n = 9, 41%), capnography (n = 3, 14%), blood gases (n = 2, 9%) and polysomnography (n = 14, 64%). Laryngotracheoscopy was routinely used in 21 of the 22 (95.5%) protocols. After decannulation, patients are transferred to the ward or intensive care unit, most of them staying in room air and for an observation period of no more than 48 hours (77% of protocols). In the proposed protocol for HDE, the child considered fit for decannulation must be without the need for ventilatory support, tolerate the reduction in the size of the tracheostomy tube and the use of a lid, without desaturation or signs of respiratory difficulty, daytime, nighttime or in exercise.  Conclusions Evidence-based guidelines that standardize pediatric tracheostomy care and the decannulation process remain a priority.]]></p></abstract>
<kwd-group>
<kwd lng="pt"><![CDATA[descanulação]]></kwd>
<kwd lng="pt"><![CDATA[traquestomia pediátrica]]></kwd>
<kwd lng="pt"><![CDATA[protocolo]]></kwd>
<kwd lng="en"><![CDATA[decannulation]]></kwd>
<kwd lng="en"><![CDATA[pediatric tracheotomy]]></kwd>
<kwd lng="en"><![CDATA[protocol]]></kwd>
</kwd-group>
</article-meta>
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