Care of the Child with a Chronic Tracheostomy

Jm, Sherman; Davis, Sheila; Albamonte-Petrick, S; Rl, Chatburn; Fitton, Cynthia M.; Green, C; Johnston, Joy; Rk, Lyrene; Myer, Charles M.; Hb, Othersen; Wood, Richelle; Zach, M; Zander, Janet; Zinman, Raezelle

doi:10.1164/ajrccm.161.1.ats1-00

Cited by 190 publications

(19 citation statements)

References 26 publications

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“…There has been a rapid increase in the growth rate of patients who have received ventilator support due to respiratory failure (17). We demonstrated weight gain and increased BMI values in almost all malnourished patients after discharge.…”

Section: Discussionmentioning

confidence: 60%

“…There is no consensus on the frequency of tube changes for children (17). The advantages of frequent tube changes include decreased airway infection and/or airway granulomas, and reduced incidence of tube occlusion by secretions.…”

Section: Discussionmentioning

confidence: 99%

“…The advantages of frequent tube changes include decreased airway infection and/or airway granulomas, and reduced incidence of tube occlusion by secretions. On the other hand, possible stretching of the tracheostomy stoma in case of cuffed tracheostomy tubes and patient discomfort are the main disadvantages (17). It is widely accepted that flexible PVC tubes can be used for 3 -4 months before being changed.…”

Section: Discussionmentioning

confidence: 99%

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Clinical Evaluation of Invasive Home Mechanical Ventilation Dependent Pediatric Patients

et al. 2017

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Objectives: With the advancements in neonatal and pediatric intensive care services and technology, the number of children requiring long term mechanical ventilation support is increasing. Home mechanical ventilators enable discharge of patients with chronic respiratory failure from hospital and allows children to grow in natural environment. The objective of this study was to define clinical characteristics and follow up results of pediatric patients who are dependent on invasive home mechanical ventilation support. Methods:This retrospective study included a total of 61 patients discharged from pediatric intensive care unit while on mechanical ventilation (HMV). Results:The median age of patients was 8.5 (2 -196) months with 60% of them being younger than 12 months. The decision for HMV was made after median 38 ± 37.2 days of mechanical ventilation in hospital. The most common reason of dependency on invasive HMV was found as central nervous system and neuromuscular diseases by 94%. The median duration of follow up was 11 months (4 days-7.5 years). HMV was no longer necessary in 12% of patients ventilated for neurological reasons and 50% for chronic pulmonary diseases. Anthropometric measures were observed to be improved in 69% of the patients. Mortality rate attributed to complications of tracheostomy was 15% and overall mortality was found as 46.7%. Conclusions:HMV enables ventilator dependent patients to be discharged and allows patients to develop and grow in their natural environment which helps them to catch up their growth potentials. The survival and quality of life (QoL) of these patients can be improved by family education and with the support by nutrition and care rehabilitation programs.

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Section: Discussionmentioning

confidence: 60%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Clinical Evaluation of Invasive Home Mechanical Ventilation Dependent Pediatric Patients

et al. 2017

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“…These recommendations are currently based on expert opinion and small observational studies 8, 9, 10, 11. No consensus exists regarding the frequency of TT changes in a mature stoma, whether the tube or inner cannula should be cleaned in a specific way or solution, or for how long a tube can be reused safely 12, 13…”

Section: Introductionmentioning

confidence: 99%

Effect of repeated tracheostomy tube reprocessing on biofilm formation

et al. 2015

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Objectives/HypothesisTo determine the effect of repeated reprocessing of pediatric tracheostomy tubes (TTs) on biofilm formation.Study DesignIn vitro microbiological study.MethodsPediatric, uncuffed, polyvinyl chloride (PVC) TTs from two different manufacturers (Tracoe Mini and Shiley) were reprocessed mechanically with household detergent and soaked in sodium hypochlorite (bleach). Two TTs of each brand were reprocessed 0 (control), 10, or 20 times. Twenty 2‐mm coupons were then obtained from each TT, immersed in human mucus, and cultured with either Staphylococcus aureus or Pseudomonas aeruginosa. Biofilm formation was evaluated with bacterial counts.ResultsBacterial counts of S. aureus for both brands were significantly higher on the TTs that were reprocessed 20 times compared to those that were not reprocessed (Tracoe: P = .040, Shiley: P < .0001) or those that were reprocessed 10 times (Tracoe: P = .022, Shiley: P = .0002). There was no difference between controls and TTs reprocessed 10 times (Tracoe: P = .76, Shiley: P = .24). P. aeuruginosa counts were not significantly different among the varying numbers of reprocessing cycles for either Tracoe or Shiley TTs (P = .08 and P = .97, respectively).ConclusionsRepeated reprocessing of PVC TTs with detergent and bleach paradoxically promotes S. aureus biofilm development, possibly due to degradation of the tube surface that facilitates bacterial attachment. Further investigation is needed to determine the optimal technique and limits of reprocessing TTs in clinical practice.Level of EvidenceNA Laryngoscope, 126:996–999, 2016

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“…Silicone tracheostomy tubes do not stiffen after repeated use or after cleaning and disinfection. However, the silicone tubes should be inspected before each use, as cracks or tears may occasionally develop [12]. Patients and/or caregivers should be instructed on the proper technique for suctioning, including the frequency and indications for this intervention.…”

Section: Discussionmentioning

confidence: 99%

Analysis of morbidity, mortality, and risk factors of tracheostomy-related complications in patients with oral and maxillofacial cancer

Lee

Kim

Jeon

et al. 2016

Maxillofac Plast Reconstr Surg

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BackgroundThis study aimed to analyze and describe the morbidity and mortality associated with tracheostomy in patients with oral cancer and to identify the risk factors associated with tracheostomy complications.MethodsWe performed a retrospective chart review of patients who underwent tracheostomy during a major oral cancer resection between March 2001 and January 2016 at the National Cancer Center, Korea. Overall, we included 51 patients who underwent tracheostomy after oral cancer surgery. We assessed the morbidity and mortality of tracheostomy and determined the risks associated with tracheostomy complications.ResultsTwenty-two tracheostomy-related complications occurred in 51 patients. The morbidity and mortality rates were 35.2 % (n = 18) and 0 % (n = 0), respectively. Tracheostomy-related complications were tracheitis (n = 4), obstructed tracheostomy (n = 9), displaced tracheostomy (n = 5), air leakage (n = 1), stomal dehiscence (n = 1), and decannulation failure (n = 2). Most complications (19/22) occurred during the early postoperative period. Considering the risk factors for tracheostomy complications, the type of tube used was associated with the occurrence of tracheitis (p < 0.05). Additionally, body mass index and smoking status were associated with tube displacement (p < 0.05). However, no risk factors were significantly associated with obstructed tracheostomy.ConclusionsPatients with risk factors for tracheostomy complications should be carefully observed during the early postoperative period by well-trained medical staff.

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Care of the Child with a Chronic Tracheostomy

Cited by 190 publications

References 26 publications

Clinical Evaluation of Invasive Home Mechanical Ventilation Dependent Pediatric Patients

Clinical Evaluation of Invasive Home Mechanical Ventilation Dependent Pediatric Patients

Effect of repeated tracheostomy tube reprocessing on biofilm formation

Analysis of morbidity, mortality, and risk factors of tracheostomy-related complications in patients with oral and maxillofacial cancer

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