Impact of COVID-19 on carers of children with tracheostomies

Hall, Nicola; Rousseau, Nikki; Hamilton, David W.; Simpson, AJ; Powell, Steven; Brodlie, Malcolm; Powell, Jason

doi:10.1136/archdischild-2021-322979

Cited by 6 publications

(14 citation statements)

References 23 publications

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“…The impact associated with changes to these systems and processes that were specifically as a result of the COVID-19 pandemic and the need for infection control, such as restrictions on visitors and personal protective equipment requirements, is described in more detail elsewhere. 30 …”

Section: Resultsmentioning

confidence: 99%

“…Table 3 includes example quotes that help to illustrate accounts of the challenges and subthemes associated with the variability in access to support and care. The impact associated with changes to these systems and processes that were specifically as a result of the COVID-19 pandemic and the need for infection control, such as restrictions on visitors and personal protective equipment requirements, is described in more detail elsewhere 30…”

Section: Resultsmentioning

confidence: 99%

“…As a consequence of the timing of data collection, the COVID-19 pandemic was also a key theme, and this has been described elsewhere. 30 …”

Section: Discussionmentioning

confidence: 99%

“…This was an important contextual factor that was accounted for during the interpretation of our findings but was not the focus of this analysis and is described in more detail elsewhere. 30 …”

Section: Methodsmentioning

confidence: 99%

“…Data collection took place during the early stages of the COVID-19 pandemic, which had a substantial impact on the experiences of caregiving at the time of the interviews. This was an important contextual factor that was accounted for during the interpretation of our findings but was not the focus of this analysis and is described in more detail elsewhere 30…”

Section: Methodsmentioning

confidence: 99%

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Providing care for children with tracheostomies: a qualitative interview study with parents and health professionals

et al. 2023

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ObjectivesTo explore the experience of caring for children with tracheostomies from the perspectives of parents and health professional caregivers.DesignQualitative semistructured interview study.SettingOne region in England covered by a tertiary care centre that includes urban and remote rural areas and has a high level of deprivation.ParticipantsA purposive sample of health professionals and parents who care for children who have, or have had, tracheostomies and who received care at the tertiary care centre.InterventionInterviews undertaken by telephone or video link.Primary and secondary outcome measuresQualitative reflexive thematic analysis with QSR Nvivo 12.ResultsThis paper outlines key determinants and mediators of the experiences of caregiving and the impact on psychological and physical health and quality of life of parents and their families, confidence of healthcare providers and perceived quality of care. For parents, access to care packages and respite care at home as well as communication and relationships with healthcare providers are key mediators of their experience of caregiving, whereas for health professionals, an essential influence is multidisciplinary team working and support. We also highlight a range of challenges focused on the shared care space, including: a lack of standardisation in access to different support teams, care packages and respite care, irregular training and updates, and differences in health provider expertise and experiences across departments and shift patterns, exacerbated in some settings by limited contact with children with tracheostomies.ConclusionsUnderstanding the experiences of caregiving can help inform measures to support caregivers and improve quality standards. Our findings suggest there is a need to facilitate further standardisation of care and support available for parent caregivers and that this may be transferable to other regions. Potential solutions to be explored could include the development of a paediatric tracheostomy service specification, increasing use of paediatric tracheostomy specialist nurse roles, and addressing the emotional and psychological support needs of caregivers.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

“…As a consequence of the timing of data collection, the COVID-19 pandemic was also a key theme, and this has been described elsewhere. 30 …”

Section: Discussionmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

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Providing care for children with tracheostomies: a qualitative interview study with parents and health professionals

et al. 2023

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A systematic review of antimicrobial therapy in children with tracheostomies

Pearce,

Talks,

Powell

et al. 2023

Pediatric Pulmonology

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Tracheostomies are indicated in children to facilitate long‐term ventilatory support, aid in the management of secretions, or manage upper airway obstruction. Children with tracheostomies often experience ongoing airway complications, of which respiratory tract infections are common. They subsequently receive frequent courses of broad‐spectrum antimicrobials for the prevention or treatment of respiratory tract infections. However, there is little consensus in practice with regard to the indication for treatment/prophylactic antimicrobial use, choice of antimicrobial, route of administration, or duration of treatment between different centers. Routine antibiotic use is associated with adverse effects and an increased risk of antimicrobial resistance. Tracheal cultures are commonly obtained from pediatric tracheostomy patients, with the aim of helping guide antimicrobial therapy choice. However, a positive culture alone is not diagnostic of infection and the role of routine surveillance cultures remains contentious. Inhaled antimicrobial use is also widespread in the management of tracheostomy‐associated infections; this is largely based on the theoretical benefits of higher airway antibiotic concentrations. The role of prophylactic inhaled antimicrobial use for tracheostomy‐associated infections remains largely unproven. This systematic review summarizes the current evidence base for antimicrobial selection, duration, and administration route in pediatric tracheostomy‐associated infections. It also highlights significant variation in practice between centers and the urgent need for further prospective evidence to guide the management of these vulnerable patients.

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Tracheostomy and long‐term invasive ventilation decision‐making in children: A scoping review

Mack,

Mailo,

Ofosu

et al. 2024

Pediatric Pulmonology

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An increasing number of children are surviving critical illnesses requiring tracheostomy/long‐term ventilation (LTV). This scoping review seeks to collate the available evidence on decision‐making for tracheostomy/LTV in children. Systematic searches of electronic databases and websites were conducted for articles and reports. Inclusion criteria included: (1) children 0–18 years old; (2) described use of tracheostomy or tracheostomy/LTV; and (3) information on recommendations for tracheostomy decision‐making or decision‐making experiences of family‐caregivers or health care providers. Articles not written in English were excluded. Of the 4463 records identified through database search and other methods, a total of 84 articles, 2 dissertations, 1 book chapter, 3 consensus statement/society guidelines, and 8 pieces of grey literature were included. Main thematic domains identified were: (1) legal and moral standards for decision‐making; (2) decision‐making models, roles of decision‐makers, and decisional aids towards a shared decision‐making model; (3) experiences and perspectives of decision‐makers; (4) health system and society considerations; and (5) conflict resolution and legal considerations. A high degree of uncertainty and complexity is involved in tracheostomy/LTV decision‐making. There is a need for a standardized decision‐support process that is consistent with a child's best interests and shared decision‐making. Strategies for optimizing communication and mechanism for managing disputes are needed.

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Impact of COVID-19 on carers of children with tracheostomies

Cited by 6 publications

References 23 publications

Providing care for children with tracheostomies: a qualitative interview study with parents and health professionals

Providing care for children with tracheostomies: a qualitative interview study with parents and health professionals

A systematic review of antimicrobial therapy in children with tracheostomies

Tracheostomy and long‐term invasive ventilation decision‐making in children: A scoping review

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