Determinants of successful tracheostomy decannulation in children: a multicentric cohort study

Schweiger, Cláudia; Manica, Denise; Neto, José Faibes Lubianca; Sekine, Leo; Krumenauer, Rita Carolina Pozzer; Caixeta, Juliana Alves; Maunsell, Rebecca; Avelino, Melissa

doi:10.1017/s0022215119002573

Cited by 14 publications

(9 citation statements)

References 14 publications

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“…As reported in previous studies, the most common underlying comorbidity in children with tracheostomy were neurologic disorders in our study 19,20 . Fourteen of 22 children had a neurologic illnes, and additonal four children had a concomittan neurologic impairment such as hypotonia.…”

Section: Discussionsupporting

confidence: 84%

The effects of nebulized antibiotics in children with tracheostomy

Atağ¹,

Ünal²,

Arslan³

et al. 2020

Preprint

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Introduction Children with tracheostomy have an increased risk of bacterial colonization and infections of the lower respiratory tracts. This study aimed to investigate the effects of nebulized antibiotics on the bacterial load, the need for oral antibiotic courses, the number of hospitalizations, and the length of stay in the intensive care unit in children with tracheostomy. Methods Children with tracheostomy and persistent bacterial colonization who were started on nebulized antibiotic therapy after a lower respiratory tract infection were included to the study. Nebulized gentamicin or colistin were used according to the results of tracheal aspirate cultures. Demographic and clinic characteristics were recorded from one year before until 12 months after initiating nebulized antibiotic treatment. Results Nebulized antibiotic treatment was initiated in 22 patients. Inhaled gentamicin was administered to 14 patients (63.6%) and colistin to 8 patients (36.4%). The median duration of treatment was 3 months (2-5 months). Following nebulized antibiotic treatment, median number of hospitalizations decreased from 2 (1-3.5) to 1 (0-1.5) (p=0.04). The median length of stay in the intensive care unit reduced significantly from 89.5 days (43-82.5) to 25 days (7.75-62.75) after starting nebulized antibiotics (p = 0.028). Following nebulized antibiotic treatment colony count also decreased (105 CFU/ml (105-106) vs. 6x104 CFU/ml (104-105); p=0.003). Conclusions Nebulize antibiotics are a reasonable treatment option for lower respiratory tract infections for tracheotomized children with persistent colonization. Further studies are needed to determine the main indications and the optimal duration and doses of the long-term nebulized antibiotic treatment in these patients.

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Section: Discussionsupporting

confidence: 84%

The effects of nebulized antibiotics in children with tracheostomy

Atağ¹,

Ünal²,

Arslan³

et al. 2020

Preprint

View full text Add to dashboard Cite

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“… Note : Schweiger et al 15 , Maslan et al 19 , Prickett et al 26 , and Al‐Saati et al 8 were excluded from this analysis as the primary indication for tracheostomy was not clearly described. …”

Section: Resultsmentioning

confidence: 99%

“…However, only three protocols monitored children for the 24-48-h period suggested by the ATS. 6,15,16 Some authors suggest that shorter observation periods are safe and promote resource conservation. For example, Prickett and Sobol 26 found that all decannulation failures in their study occurred within the first 12 h. Observation typically occurred on the inpatient ward or ICU setting.…”

Section: Discussionmentioning

confidence: 99%

“…In our review, 76% of children were observed for 48 h or less. However, only three protocols monitored children for the 24–48‐h period suggested by the ATS 6,15,16 . Some authors suggest that shorter observation periods are safe and promote resource conservation.…”

Section: Discussionmentioning

confidence: 99%

“…The remaining four studies with 270 children did not clearly describe the primary reason for tracheostomy and were excluded from this analysis. 8,14,15,19 Tracheostomy indications were sorted into three categories based on a recent classification scheme for pediatric tracheostomy by Mitchell et al 35 These categories included (1) upper airway obstruction at a well-defined anatomic site (401/1141, 35%); (2) upper airway obstruction not at a well-defined anatomic site or due to an underlying medical condition (136/1141, 12%); and (3) need for access to the lower airway for long-term ventilation and pulmonary care (588/1141, 53%). The second category refers to children with craniofacial anomalies and multiple sites of upper airway obstruction rather than one fixed anatomic site.…”

Section: Indications For Tracheostomymentioning

confidence: 99%

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Decannulation following tracheostomy in children: A systematic review of decannulation protocols

Verma

Mocanu

Shi

et al. 2021

Pediatric Pulmonology

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Objective: To provide a systematic review of the existing pediatric decannulation protocols, including the role of polysomnography, and their clinical outcomes.Methods: Five online databases were searched from database inception to May 29, 2020. Study inclusion was limited to publications that evaluated tracheostomy decannulation in children 18 years of age and younger. Data extracted included patient demographics and primary indication for tracheostomy. Methods used to assess readiness for decannulation were noted including the use of bronchoscopy, tracheostomy tube modifications, and gas exchange measurements. After decannulation, details regarding mode of ventilation, location, and length of observation period, and clinical outcomes were also collected. Descriptive statistical analyses were performed.Results: A total of 24 studies including 1395 children were reviewed.Tracheostomy indications included upper airway obstruction at a well-defined anatomic site (35%), upper airway obstruction not at a well-defined site (12%) and need for long-term ventilation and pulmonary care (53%). Bronchoscopy was routinely used in 23 of 24 (96%) protocols. Tracheostomy tube modifications in the protocols included capping (n = 20, 83%), downsizing (n = 14, 58%), and fenestrations (n = 2, 8%). Measurements of gas exchange included polysomnography (n = 13/18, 72%), oximetry (n = 10/18, 56%), blood gases (n = 3,17%), and capnography (n = 3, 17%). After decannulation, children in 92% of protocols were transitioned to room air. Observation period of 48 h or less was used in 76% of children.Conclusions: There exists large variability in pediatric decannulation protocols.Polysomnography plays an integral role in assessing most children for tracheostomy removal. Evidence-based guidelines to standardize pediatric tracheostomy care remain an urgent priority.

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Indications and Outcomes for Tracheostomies in Pediatric Oncology Patients—A Single Center Study

Pan,

Lucas,

Okcu

et al. 2024

Pediatric Blood & Cancer

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BackgroundChildren with cancer face a high risk of complications including prolonged mechanical ventilation requiring tracheostomies. While tracheostomies have been demonstrated to be a generally safe procedure, there remain significant rare complications and a paucity of literature addressing outcomes specifically for pediatric patients with cancer. The objective of this study was to characterize pediatric patients with cancer who underwent tracheostomies and describe their indications and outcomes for length of stay, decannulation, and complications.ProceduresAt a single large volume children's hospital, retrospective medical record analysis was performed in all pediatric patients with cancer who received tracheostomies from 2004 to 2023.ResultsSixty‐five patients were identified with a median follow‐up time of 763 days (interquartile range 302–1687). Twenty‐one (32%) patients had a tracheostomy placed due to complications from mass effect of the tumor, 16 (25%) due to complications from cancer treatment, and 14 (22%) had a tracheostomy placed for nononcologic reasons. Additionally, a distinct subgroup of 14 (22%) patients underwent tracheostomy perioperatively for elective airway management during surgical resection of their tumors. Twenty‐nine (45%) were decannulated and 17 (26%) patients had a tracheostomy‐associated complication, including tracheitis and tracheocutaneous fistula, and no patients had a tracheostomy‐associated mortality.ConclusionsThe incidence of tracheostomy‐associated complications and decannulation rates in pediatric patients with cancer was comparable with the general pediatric tracheostomy population. This study establishes a reference point for clinicians regarding the anticipated outcomes among pediatric patients with cancer requiring or having undergone a tracheostomy.

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Determinants of successful tracheostomy decannulation in children: a multicentric cohort study

Cited by 14 publications

References 14 publications

The effects of nebulized antibiotics in children with tracheostomy

The effects of nebulized antibiotics in children with tracheostomy

Decannulation following tracheostomy in children: A systematic review of decannulation protocols

Indications and Outcomes for Tracheostomies in Pediatric Oncology Patients—A Single Center Study

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