Incidence, Epidemiology, and Outcomes of Pediatric Tracheostomy in the United States from 2000 to 2012

Müller, R.; Mamidala, Madhu; Smith, Stanley W.; Smith, Aaron; Sheyn, Anthony

doi:10.1177/0194599818803598

Cited by 97 publications

(125 citation statements)

References 19 publications

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“…Since the 1980s there has been a decline in indications for pediatric tracheostomy in infection with the implementation of the Haemophilus influenzae type B and Corynebacterium diptheriae vaccinations. 1,[17][18][19]21,22 This is coupled with improvements in intensive care and increasing survival rates of premature infants.…”

Section: Discussionmentioning

confidence: 99%

“…In 2012, infants (children < 3 years of age) represented one-half of the nearly 4400 pediatric tracheostomies that occurred in the United States. 1 Patients under 1 year of age composed over 40% of these pediatric tracheostomies. 1 Among the many indications for tracheostomy placement in this population include congenital anomalies, preterm births, acquired laryngeal stenosis, and bronchopulmonary dysplasia (BPD).…”

Section: Introductionmentioning

confidence: 99%

“…1 Patients under 1 year of age composed over 40% of these pediatric tracheostomies. 1 Among the many indications for tracheostomy placement in this population include congenital anomalies, preterm births, acquired laryngeal stenosis, and bronchopulmonary dysplasia (BPD). These indications are not mutually exclusive.…”

Section: Introductionmentioning

confidence: 99%

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Survival analysis and decannulation outcomes of infants with tracheotomies

et al. 2019

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Objective To evaluate for differences in time to decannulation and survival rates for pediatric tracheotomy patients based on ventilator status upon discharge. Study Design Retrospective longitudinal cohort study. Methods A single‐institution longitudinal study of pediatric tracheostomy patients was conducted. Patients were categorized based on mechanical ventilation status on discharge and principal reason for tracheostomy. Survival rates were determined using the Kaplan‐Meier method. The Wilcoxon's Rank Sum test and Cox regression analysis evaluated differences in survival times and time to decannulation based on primary indication for tracheotomy and ventilation status. Results Chart review identified 305 patients who required a tracheostomy under the age of 3. The median age at the time of tracheotomy was 5.2 months. The indications for tracheotomy in these patients were airway obstruction in 145 (48%), respiratory failure in 214 (70%), and pulmonary toilet in 10 (3.3%). Seventy‐nine percent of patients were ventilator dependent at discharge. At the conclusion of the study period, 55% of patients were alive with tracheostomy in place, 30% patients were decannulated, and 15% patients were deceased. Patients with ventilator dependence at initial discharge, bronchopulmonary dysplasia, or airway obstruction were more likely to be decannulated. Hispanic patients were less likely to be decannulated. Patients had an equal probability of death regardless of ventilator status at discharge. Conclusions This study demonstrated that the time to decannulation and likelihood of decannulation varies based on the indication for the tracheostomy. The majority of patients with a tracheostomy were not decannulated at the conclusion of this study. Median time to decannulation was 2.5 years for patients with a median death time of 6 months. Level of Evidence 2b Laryngoscope, 130:2319–2324, 2020

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Survival analysis and decannulation outcomes of infants with tracheotomies

et al. 2019

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“…This built on a number of much older series published . More recently, larger scale databases studies have been published based on historic data . A number of recent studies have also specifically investigated aspects of tracheostomy safety and compilations .…”

Section: Introductionmentioning

confidence: 99%

Pediatric tracheostomy: A large single‐center experience

et al. 2019

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Objectives: To describe the epidemiology, specifically the indications, complications, and outcomes, of pediatric tracheostomies performed in one tertiary referral unit.Methods: Single-center retrospective cohort study of pediatric patients undergoing tracheostomy between May 2010 and May 2018 at the Newcastle upon Tyne Hospitals, United Kingdom.Results: One hundred seventy-two pediatric tracheostomies were performed during the study period with a median age of 141 (interquartile range [IQR] 51-484) days. The most common primary indication was long-term ventilation (38.4%, 66 of 172), followed by weaning from ventilation in cardiac patients (22.1%, 38 of 172). Only 5.2% (9 of 172) of our cohort underwent tracheostomy for subglottic stenosis. The vast majority of tracheostomies were performed electively, with just 6.4% (11 of 172) performed as an emergency procedure. Early and late complication rates were 9.8% (15 of 153) and 40.0% (61 of 153), respectively. Tracheostomy decannulation was successful in 44.4% of children (68 of 153). The median duration the tracheostomy was in situ was 397 (IQR 106-708) days. All-cause mortality was 22.1% (38 of 172), with tracheostomy-related mortality at 1.2% (2 of 172).Conclusion: We report one of the largest contemporary case series of pediatric tracheostomies. Present-day pediatric tracheostomy is primarily performed as an elective procedure in ventilated children under the age of 1 year. Pediatric tracheostomy should be considered as a long-term intervention in many children. Nevertheless, a large proportion of children are ultimately decannulated. It is important to acknowledge the significant morbidity associated with this intervention and the small-but-present risk of tracheostomy-related mortality.

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“…In the United States, approximately 4,500 to 5,000 pediatric tracheostomies are performed annually . Indications for tracheostomy include congenital and acquired upper airway obstruction, as well as the need for prolonged mechanical ventilation due to pulmonary, neurological, or neuromuscular disease .…”

Section: Introductionmentioning

confidence: 99%

Surveillance endoscopy after tracheostomy placement in children: Findings and interventions

et al. 2019

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Objectives/Hypothesis The Seattle Children's Hospital implemented the Trach Safe Initiative to improve airway safety in tracheostomy‐dependent children (TDC). A key tenet of this initiative is surveillance endoscopy. The objectives of this study were to describe the prevalence of abnormal airway changes in TDC, identify risk factors for these changes, and describe the frequency of airway interventions. Study Design Retrospective case series. Methods This is a review of children 0 to 21 years old who underwent tracheostomy and surveillance endoscopy from February 1, 2014 to January 1, 2019. Descriptive statistics were used to report the prevalence of abnormal airway changes and interventions following tracheostomy. Pearson χ2 tests and logistic regression were used to identify risk factors for the development of abnormal changes. Results There were 127 children identified. The median time from tracheostomy to initial surveillance endoscopy was 1.6 months (interquartile range = 1.3–2.4 months). At initial endoscopy, 86.6% of patients had at least one abnormal airway finding. The most common findings were subglottic edema/stenosis (57.3%), glottic edema (37.3%), and suprastomal granulation tissue (31.8%). Prematurity and a history of failed extubations were significantly associated with abnormal findings on endoscopy (odds ratio [OR] = 7.2, P = .01 and OR = 4.1, P = .03, respectively). Of those with abnormal findings, 32.7% underwent an intervention to improve airway patency and safety. The most common interventions performed were suprastomal granuloma excision (44.4%), steroid injection (22.2%), and balloon dilation of the glottis or subglottis (19.4%). Conclusions The prevalence of early abnormal airway changes in TDC is high, particularly in young children with a history of prematurity and failed extubation. Level of Evidence 4 Laryngoscope, 130:1327–1332, 2020

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Incidence, Epidemiology, and Outcomes of Pediatric Tracheostomy in the United States from 2000 to 2012

Cited by 97 publications

References 19 publications

Survival analysis and decannulation outcomes of infants with tracheotomies

Survival analysis and decannulation outcomes of infants with tracheotomies

Pediatric tracheostomy: A large single‐center experience

Surveillance endoscopy after tracheostomy placement in children: Findings and interventions

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