Enhanced Tracheostomy Wound Healing Using Maltodextrin and Silver Alginate Compounds in Pediatrics: A Pilot Study

Abstract

BACKGROUND: Tracheostomy wounds are commonly encountered in children but rarely reported. Relatively few treatments are available or have been investigated to manage this problem. Healing times for pediatric tracheostomy wounds are often unpredictable and protracted. Recent use of maltodextrin gel (MD) and a silver alginate sponge (AG) at our institution has demonstrated expedited healing and interest in this novel treatment for tracheostomy wounds. METHODS: We conducted an 11-month retrospective review of children with wound complications following tracheostomy placement at a tertiary care facility. Wounds were evaluated and rated based upon the National Pressure Ulcer Advisory Panel staging system. Subjects identified with stage 2 or greater tracheostomy-related ulcers treated with MD and/or AG were included. Subject characteristics and wound healing rates were tabulated in a database that included age, wound site, initial and final wound stage, type of treatment, length of treatment, and complications. Tracheostomy wounds treated as an out-patient were excluded from the study. RESULTS: Eighteen subjects, which included both in-patients and out-patients, were treated with AG and/or MD during the study period for tracheostomy-related wounds. Of the 26 subjects with tracheostomies performed during the study period, 10 (38.5%) were treated for postoperative wounds. A total of 11 subjects completed their in-patient wound treatment and were thus included in the study. Average subject age was 5.3 y (range 0.25-15.6 y). Wound locations were as follows: infrastomal region (n ‫؍‬ 8), stoma (n ‫؍‬ 2), and lateral neck (n ‫؍‬ 1). Six subjects had stage 2 wounds, 4 had stage 3 wounds, and 1 had a stage 4 ulcer. All wounds achieved complete epithelialization following treatment with MD and/or AG. The average length of treatment was 12.8 d (range 6 -28 d). No adverse effects were identified. CONCLUSIONS: Postoperative tracheostomy wounds are common. The use of MD and AG provides an effective and safe treatment for tracheostomy-related ulcers.

Update on Pediatric Tracheostomy: Indications, Technique, Education, and Decannulation

“…Despite these efforts, pressure ulcers occur nearly 10% of all tracheostomies. Maltodextrin gel and/or silver alginate sponges has been demonstrated to be effective in improving stoma and wound breakdown in these patients [44]. This can be used as a preventive measure or after the development of injury.…”

Tracheostomy Placement in Children Younger Than 2 Years

“…In addition, no standardization of protocols for tracheostomy placement and care exists between institutions. 4,[6][7][8][9] The American College of Surgeons established the National Surgical Quality Improvement Program (NSQIP) in 2004 and the NSQIP Pediatric in 2008 to measure quality of care among surgical patients. 10,11 With the passage of the 2008 Medicare Improvements for Patients and Providers Act and the 2010 Patient Protection and Affordable Care Act, which call for setting national priorities for improvement in quality and recommend use of performance measures in federal programs to achieve these priorities, 12 the NSQIP Pediatric provides an opportunity to apply and measure the effect of multi-institutional quality improvement initiatives in improving surgical outcomes for children.…”

Maltodextrin enhances biofilm elimination by electrochemical scaffold

“…This achieved an overall log-reduction of 8.27 ± 0.05 for Gram-negative A. baumannii and 4.71 ± 0.12 for Gram-positive S. aureus biofilms over 24 h, which is significantly more effective than reports for other antimicrobial technologies. Both H 2 O 2 and maltodextrin are individually used in wound care5166676869. We previously demonstrated that an e-scaffold generates a low concentration of H 2 O 2 that can be an effective, nontoxic alternate treatment for biofilm-infected wounds10.…”

“…We previously demonstrated that an e-scaffold generates a low concentration of H 2 O 2 that can be an effective, nontoxic alternate treatment for biofilm-infected wounds10. Maltodextrin benefits wound healing by promoting collagen formation, granulation tissue growth and epithelial proliferation52697071. The combination of an e-scaffold and maltodextrin clearly enhances the elimination of biofilms of two nosocomial infectious agents, Gram-negative A. baumannii and Gram-positive S. aureus .…”