Epidemiology of Pediatric Tracheostomy and Risk Factors for Poor Outcomes: An 11‐Year Single‐Center Experience

Chia, Aletheia Z H; Ng, Zhi Min; Pang, Yu Xian; Ang, Annette Hui-Chi; Chow, Cristelle; Teoh, Oon Hoe; Lee, Jan Hau

doi:10.1177/0194599819887096

Cited by 26 publications

(35 citation statements)

References 22 publications

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“…Despite the high degree of complexity of the patient population, in-hospital mortality rates are consistent with previous studies on pediatric tracheostomy. 9,31,32 As expected, complex patients were significantly more likely to die during their index admissions than non-complex patients (OR = 11.6, 95% CI: 1.5-91.3, P < .02). Complex patients in this population were younger, which is consistent with previous reports that neonates and infants with tracheostomies are at highest risk of mortality among all pediatric patients.…”

Section: Discussionsupporting

confidence: 65%

Perioperative Outcomes After Tracheostomy Placement Among Complex Pediatric Patients

et al. 2021

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Objectives/Hypothesis: To compare perioperative outcomes after pediatric tracheostomy placement based on patient complexity.Study Design: Retrospective case series.Methods: All patients that underwent tracheostomy placement at a tertiary children's hospital between 2015 and 2019 were followed. Children with a history of major cardiac surgery, sepsis, or total parental nutrition (TPN) were grouped as complex. Admission length, tracheostomy-related complications, in-hospital mortality, and 30-day readmissions were recorded among complex and non-complex patients.Results: A total of 238 children were included. Mean age at tracheostomy was 39.9 months (SD: 61.3), 51% were male and 51% were complex. Complex patients were younger at admission (29.9 vs. 46.8 months, P = .03), more likely to have respiratory failure (81% vs. 53%, P < .001) and more often required mechanical ventilation at discharge (86% vs. 67%, P < .001). An additional 33 days after placement was required for complex children (95% CI: 14-51, P = .001) and this group had more deaths (8% vs. 1%, P = .02); however, both groups had similar complication and readmission rates (P > .05). Total charges were higher among complex patients ($700,267 vs. $338,937, P < .001). Parametric survival analysis identified mechanical ventilation and patient complexity interacting to predict post-tracheostomy admission length.Conclusions: Hospital discharge after pediatric tracheostomy was associated with patient complexity and further influenced by mechanical ventilation. Recognition that cardiac surgery, sepsis, or TPN can predict poorer perioperative outcomes can provide quality improvement strategies for these vulnerable children.

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Section: Discussionsupporting

confidence: 65%

Perioperative Outcomes After Tracheostomy Placement Among Complex Pediatric Patients

et al. 2021

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“…The reported decannulation rate in children varied from 23 to 70%. 2 , 4 , 18 , 27 Similar to our study, Zank et al reported a higher rate of successful decannulation in UAO and trauma cases. 22 On the contrary, Canning et al reported UAO as high risk for unsuccessful decannulation.…”

Section: Discussionsupporting

confidence: 90%

“…It seems that the average age at the time of tracheostomy in different studies depended on the most frequent indication. 25 Younger age-group was reported in studies in which UAO, craniofacial anomalies, and cardiac diseases were predominant indications 4 , 18 while older age >3 years was observed in studies when neurological impairment was the cause in the majority of children. 23 , 24 A similar observation was present in our study and by Lin et al 24 …”

Section: Discussionmentioning

confidence: 97%

“… 1 Later on, congenital or acquired anatomical narrowing of upper airways became frequent indications. 16 – 18 In third-world countries, infections are still reported as a common indication. 19 , 20 With better airway management and improving critical care, more number of tracheostomies were performed for prolonged ventilation, cardiopulmonary diseases, and neurological impairment.…”

Section: Discussionmentioning

confidence: 99%

“…The complication rate is higher and varies in different studies on pediatric tracheostomies (18–80%) as compared to that in adults. 5 , 18 – 21 The most dreaded immediate or early complications before the first tube change were tube block, accidental tube removal, and major surgical emphysema. There were five deaths before the first tube change in the present study.…”

Section: Discussionmentioning

confidence: 99%

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Tracheostomy in Pediatric Intensive Care Unit—A Two Decades of Experience

Sachdev

Chaudhari

Singh

et al. 2021

Indian Journal of Critical Care Medicine

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A bstract Aim and objective To study the profile, indications, related complications, and predictors of decannulation and mortality in patients who underwent tracheostomy in the pediatric intensive care unit (PICU). Materials and methods Retrospective analysis of prospectively collected data of tracheostomies was done on patients admitted at PICU. Demographics, primary diagnosis, indication of tracheostomy, and durations of endotracheal intubation, mechanical ventilation, and tracheostomy cannulation were recorded. The indication was recorded in one of the four categories—upper airway obstruction (UAO), central neurological impairment (CNI), prolonged mechanical ventilation, and peripheral neuromuscular disorders). Results Two hundred ninety cases were analyzed. UAO (42%) and CNI (48.2%) were main indications in the halves of the study period, respectively. Decannulation was successful in 188 (64.8%) patients. Seventy-seven percentage UAO patients were decannulated successfully [OR (odds ratio); 95% CI (confidence interval), 2.647; 1.182–5.924, p = 0.018]. Age <1 year (0.378; 0.187–0.764; p = 0.007), nontraumatic, noninfectious central neurological diseases (0.398; 0.186–0.855; p = 0.018), and malignancy (0.078; 0.021–0.298; p <0.001), durations of posttracheostomy ventilation (0.937; 0.893–0.983; p = 0.008), and stay in the PICU (0.989; 0.979–0.999; p = 0.029) were predictors of unsuccessful decannulation. There were 91 (31.4%) deaths. Age <1 year (2.39 (1.13–5.05; p = 0.02), malignancy (17.55; 4.10–75.11; p <0.001), durations of posttracheostomy ventilation (1.06; 1.006–1.10; p = 0.028), and hospital stay (1.007; 1.0–1.013; p = 0.043) were independent predictors of mortality. Indication of UAO favored survivor (0.24; 0.09–0.57; p <0.001). Conclusion The indications for tracheostomy in children had changed over the years. Infancy, primary diagnosis, length of posttracheostomy ventilation, and stay in the PICU and hospital were independent predictors of decannulation and mortality. What This Adds Similar to developed countries, the age at the time of tracheostomy and indication are changing. Inability to decannulate and mortality were associated with the age of a child at the time of tracheostomy, indication, medical diagnosis, and duration of postprocedure mechanical ventilation and stay in the hospital. How to cite this article Sachdev A, Chaudhari ND, Singh BP, Sharma N, Gupta D, Gupta N, et al . Tracheostomy in Pediatric Intensive Care Unit—A Two Decades of Experience. Indian J Crit Care Med 2021;25(7):803–81...

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An Analysis of Tracheostomy Complications in Pediatric Patients With Scoliosis

et al. 2021

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Objectives/Hypothesis To analyze tracheostomy‐related complications in pediatric patients with scoliosis. Study Design Retrospective chart review. Methods A retrospective chart review of all patients with tracheostomy and scoliosis was performed at a single institution. The charts were reviewed for variables including difficulties with tracheostomy tube changes, poor positioning of tube, abnormal appearance of trachea, and emergency room visits and admissions for complications. Decannulation rates were also identified. Results About 102 patients met inclusion criteria, 96 (94.1%) had scoliosis involving the thoracic spine, and 4 had scoliosis involving the cervical spine; 13 (12.8%) patients had documented poor positioning on tracheoscopy; 31 patients (30.3%) had at least one emergency room visit or admission for complications, such as accidental decannulation or bleeding from the tracheostomy; 19 (18.6%) patients required at least one tube change due to poor positioning, with 7 (6.9%) requiring multiple changes; 18 (17.7%) had reported difficulties with home tube changes. Custom length tubes were required in 9 patients (8.8%). The level of scoliosis was not associated with any of these complications. Abnormalities of the trachea, such as tortuosity, obstructive granulomas, or tracheomalacia, were seen in 35 patients (34.3%) on bronchoscopy. Scoliosis repair was performed in 18 patients (17.65%), of which two achieved decannulation. Ten patients (9.8%) overall were decannulated. Conclusion A portion of patients with scoliosis who are tracheostomy‐dependent have anatomical abnormalities of the trachea and poor positioning of the tracheostomy tube. Decannulation rates are also lower in this population compared to the literature. Further work is required to elucidate if scoliosis predisposes patients toward tracheostomy‐related complications. Level of Evidence 4 Laryngoscope, 132:944–948, 2022

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Epidemiology of Pediatric Tracheostomy and Risk Factors for Poor Outcomes: An 11‐Year Single‐Center Experience

Cited by 26 publications

References 22 publications

Perioperative Outcomes After Tracheostomy Placement Among Complex Pediatric Patients

Perioperative Outcomes After Tracheostomy Placement Among Complex Pediatric Patients

Tracheostomy in Pediatric Intensive Care Unit—A Two Decades of Experience

An Analysis of Tracheostomy Complications in Pediatric Patients With Scoliosis

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