A 12-year-experience with tracheostomy for neonates and infants in northern Taiwan: Indications, hospital courses, and long-term outcomes

Chen, Chia-Huei; Chang, Jui‐Hsing; Hsu, Chyong-Hsin; Chiu, Nan-Chang; Peng, Chun-Chin; Jim, Wai-Tim; Chang, Hung‐Yang; Lee, Kuo‐Sheng

doi:10.1016/j.pedneo.2017.07.003

Cited by 11 publications

(18 citation statements)

References 28 publications

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“…While the infants studied had a diversity of diagnoses that required tracheostomies including BPD, TEF and CDH, our data suggests CC could successfully reduce the rate of mortality rate, total number of hospital admissions per 100-child years and increase the hazard of having mechanical ventilation removal at 5 years. The mortality rate in our cohort was 13.9%, slightly lower than previous studies that explored the mortality associated with the presence of a mechanical ventilator and tracheostomy in children [ 14 - 21 ] (Table 5 ). Our data shows that CC as an intervention decreased mortality in technology-dependent NICU infants after discharge.…”

Section: Discussioncontrasting

confidence: 60%

The Effect of Comprehensive Medical Care on the Long-Term Outcomes of Children Discharged from the NICU with Tracheostomy

Jesus-Rojas¹,

Mosquera²,

Samuels

et al. 2018

TORMJ

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Background:Survival of infants with complex care has led to a growing population of technology-dependent children. Medical technology introduces additional complexity to patient care. Outcomes after NICU discharge comparing Usual Care (UC) with Comprehensive Care (CC) remain elusive.Objective:To compare the outcomes of technology-dependent infants discharged from NICU with tracheostomy following UC versus CC.Methods:A single site retrospective study evaluated forty-three (N=43) technology-dependent infants discharged from NICU with tracheostomy over 5½ years (2011-2017). CC provided 24-hour accessible healthcare-providers using an enhanced medical home. Mortality, total hospital admissions, 30-days readmission rate, time-to-mechanical ventilation liberation, and time-to-decannulation were compared between groups.Results:CC group showed significantly lower mortality (3.4%) versus UC (35.7%), RR, 0.09 [95%CI, 0.12-0.75], P=0.025. CC reduced total hospital admissions to 78 per 100 child-years versus 162 for UC; RR, 0.48 [95% CI, 0.25-0.93], P=0.03. The 30-day readmission rate was 21% compared to 36% in UC; RR, 0.58 [95% CI, 0.21-1.58], P=0.29). In competing-risk regression analysis (treating death as a competing-risk), hazard of having mechanical ventilation removal in CC was two times higher than UC; SHR, 2.19 [95% CI, 0.70-6.84]. There was no difference in time-to-decannulation between groups; SHR, 1.09 [95% CI, 0.37-3.15].Conclusion:CC significantly decreased mortality, total number of hospital admissions and length of time-to-mechanical ventilation liberation.

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Section: Discussioncontrasting

confidence: 60%

The Effect of Comprehensive Medical Care on the Long-Term Outcomes of Children Discharged from the NICU with Tracheostomy

Jesus-Rojas¹,

Mosquera²,

Samuels

et al. 2018

TORMJ

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“…Other cohorts have reported similar ages at tracheostomy. 15,[18][19][20] A cohort comparing age at tracheostomy between preterm and term infants also observed a trend towards lower age at tracheostomy in term infants. 5 Whether tracheostomy should be considered earlier for preterm infants is unknown, and might represent a trade-off between performing more tracheostomies and decreasing the length of hospitalization for ventilator-dependent preterm infants.…”

Section: Discussionmentioning

confidence: 95%

Tracheostomies in term and preterm infants: A single‐center Canadian retrospective cohort

Wong

Harris

Hicks

et al. 2022

Pediatric Pulmonology

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Main outcome measures: Hospital course, discharge, and 3-year post-tracheostomy outcomes were compared between preterm infants <29 weeks gestation and infants with congenital anomalies.Results: Forty-three infants were identified; seven were lost to follow-up and excluded. Of the 36 analyzed, 86% survived to discharge. At discharge, 13% were decannulated, 36% required no mechanical ventilation, and 52% required mechanical ventilation. Median hospitalization was 295 days. At 3 years post-tracheostomy, 97% were alive. Proportions of infants with tracheostomy in situ was 80%, 73%, and 60% at 1, 2, and 3 years post tracheostomy. Tracheostomy incidence was 2.7% for preterm infants <29 weeks gestational age with 55% for subglottic stenosis. All preterm infants received postnatal steroids. Preterm infants underwent tracheostomy at later chronological age (123 vs. 81 days, p < 0.001), but similar corrected gestational age (42 + 5 vs. 51 + 2 weeks, p = 0.095). Preterm infants had more intubation attempts (17 vs. 4, p < 0.001), total extubations (8 vs. 2, p < 0.001), and days on ventilation before tracheostomy (100 vs. 78, p < 0.001).Conclusions: Infants who underwent tracheostomy in a Canadian public healthcare setting demonstrated decreasing tracheostomy dependence and high survival post tracheostomy, despite prolonged hospitalization. Preterm infants had more intubation and extubation events which may have contributed to airway injury.

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“…En esta serie de pacientes traqueostomizados durante el periodo 2005 a 2015 observamos que, al igual que lo reportado en publicaciones internacionales, la edad de realización de traqueostomía se concentra en el grupo de menores de 6 meses y la indicación por necesidad de VM crece en importancia [9][10][11][12][13][14][15][16][17][18] . Gergin et al describen que entre los años 1984 a 2014 ha existido un cambio en la indicación de traqueostomía en pediatría, desde su indicación principalmente por compromiso de vía aérea y malformaciones craneofaciales, a la indicación por necesidad de VM crónica de causa cardiopulmonar o enfermedad neuromuscular 6 .…”

Section: Discussionunclassified

Traqueostomía en niños: experiencia de 10 años en una Unidad de Cuidados Intensivos Pediátricos

et al. 2021

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La indicación de traqueostomía en pediatría ha cambiado en los últimos 30 años, desde indicaciones agudas y transitorias por obstrucción de la vía aérea a indicaciones programadas y de uso crónico por necesidad de ventilación mecánica (VM) crónica.Objetivo: describir la indicación de traqueostomía y morbilidad asociada al procedimiento, en una cohorte de una década.Pacientes y Método: Estudio descriptivo. Revisión de fichas de egresos hospitalarios (2005-2015) en menores de 15 años traqueostomizados durante su estadía, en una unidad de cuidados intensivos de un hospital universitario. Se evaluaron variables demográficas y clínicas pre y post traqueostomía, estadía en unidad de intensivo, edad al momento de traqueostomía, indicación de ésta, complicaciones precoces (< 7 días), complicaciones tardías (> 7 días), y mortalidad.Resultados: Se consignaron 59 pacientes traqueostomizados, 36 (59%) de ellos menores de 6 meses y 60% en varones. El 39% tuvo una genopatía confirmada o en estudio y el 42% una cardiopatía congénita. Las principales indicaciones fueron compromiso de vía aérea (58%) y VM crónica (42%). En el subgrupo de vía aérea, las principales causas fueron estenosis subglótica, parálisis cordal y traqueobroncomalacia, mientras que en el subgrupo de VM crónica las principales indicaciones fueron displasia broncopulmonar y daño pulmonar crónico. No encontramos mortalidad asociada a traqueostomía. El 89% fue egresado con traqueostomía y el 59% con VM crónica. Los pacientes de menor edad presentaron mayor probabilidad de alta con traqueostomía y aquellos con mayor número de fallas de extubación previo a traqueostomía, presentaron mayor tasa de egreso con VM.Conclusiones: La traqueostomía es un procedimiento seguro en niños, siendo las causas preponderantes la patología de vía aérea y necesidad de VM crónica. La mayoría de los niños traqueostomizados egresó con traqueostomía y VM crónica. Los niños de menor edad, weaning difícil, genopatía confirmada o sospecha, o con necesidad especiales en salud tienen mayor riesgo de necesitar traqueostomía y VM crónica.

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A 12-year-experience with tracheostomy for neonates and infants in northern Taiwan: Indications, hospital courses, and long-term outcomes

Abstract: In this study, the most common indication for tracheostomy in neonates and infants was airway obstruction. Excluding patients with neuromuscular diseases, a successful decannulation rate of >50% can be achieved.

Cited by 11 publications

References 28 publications

The Effect of Comprehensive Medical Care on the Long-Term Outcomes of Children Discharged from the NICU with Tracheostomy

The Effect of Comprehensive Medical Care on the Long-Term Outcomes of Children Discharged from the NICU with Tracheostomy

Tracheostomies in term and preterm infants: A single‐center Canadian retrospective cohort

Traqueostomía en niños: experiencia de 10 años en una Unidad de Cuidados Intensivos Pediátricos

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