Parental report of pediatric tracheostomy care

Bahng, Susanna C.; VanHala, Sonja; Nelson, Virginia S.; Hurvitz, Edward A.; Roloff, Dietrich W.; Grady, Elizabeth A.; Lewis, Cathy

doi:10.1016/s0003-9993(98)90229-5

Cited by 15 publications

(12 citation statements)

References 10 publications

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“…22–27 Information on reuse of tracheotomy tubes or frequency of tube changes were unavailable. 71,72 Institutional care practices requiring ICU admission for children with tracheotomy may have influenced the observed ICU use in our study.…”

Section: Discussionmentioning

confidence: 92%

Predictors of Clinical Outcomes and Hospital Resource Use of Children After Tracheotomy

Berry

Graham

Graham³

et al. 2009

Pediatrics

178

200

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OBJECTIVES The objectives are to describe health outcomes and hospital resource use of children after tracheotomy and identify patient characteristics that correlate with outcomes and hospital resource use. PATIENTS AND METHODS A retrospective analysis of 917 children aged 0 to 18 years undergoing tracheotomy from 36 children’s hospitals in 2002 with follow-up through 2007. Children were identified from ICD-9-CM tracheotomy procedure codes. Comorbid conditions (neurologic impairment [NI], chronic lung disease, upper airway anomaly, prematurity, and trauma) were identified with ICD-9-CM diagnostic codes. Patient characteristics were compared with in-hospital mortality, decannulation, and hospital resource use by using generalized estimating equations. RESULTS Forty-eight percent of children were ≤6 months old at tracheotomy placement. Chronic lung disease (56%), NI (48%), and upper airway anomaly (47%) were the most common underlying comorbid conditions. During hospitalization for tracheotomy placement, children with an upper airway anomaly experienced less mortality (3.3% vs 11.7%; P < .001) than children without an upper airway anomaly. Five years after tracheotomy, children with NI experienced greater mortality (8.8% vs 3.5%; P≤.01), less decannulation (5.0% vs 11.0%; P≤.01), and more total number of days in the hospital (mean [SE]: 39.5 [4.0] vs 25.6 [2.6] days; P≤.01) than children without NI. These findings remained significant (P < .01) in multivariate analysis after controlling for other significant cofactors. CONCLUSIONS Children with upper airway anomaly experienced less mortality, and children with NI experienced higher mortality rates and greater hospital resource use after tracheotomy. Additional research is needed to explore additional factors that may influence health outcomes in children with tracheotomy.

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Section: Discussionmentioning

confidence: 92%

Predictors of Clinical Outcomes and Hospital Resource Use of Children After Tracheotomy

Berry

Graham

Graham³

et al. 2009

Pediatrics

178

200

View full text Add to dashboard Cite

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“…Patients and caregivers almost invariably prefer noninvasive aids over tracheostomy for safety, convenience, appearance, comfort, facilitating effect on speech, sleep, and swallowing, and general acceptability [16,17,18,19]. As a general principle, CRF that requires mechanical ventilation 24 h/day is most often treated with a permanent tracheostomy and positive pressure ventilation.…”

Section: Discussionmentioning

confidence: 99%

Home Ventilation for Children with Chronic Respiratory Failure in Istanbul

et al. 2007

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Background: The number of children on home mechanical ventilation (HMV) has increased markedly in Europe and North America but little is known about the HMV use and outcomes in children in Turkey. Objective: To review clinical conditions and outcome of children who were discharged from the hospital on respiratory support. Methods: Thirty-four patients assessed at the Marmara University Hospital in Istanbul who had been receiving ventilatory support at home for more than 3 months were included in the study. Results: Thirty-four patients with a median age of 5.1 years were discharged home with ventilatory support. HMV was started in 2001 at our institution and the number of children treated has increased substantially since then (2001: n = 1, 2002: n = 3, 2003: n = 3, 2004: n = 2, 2005: n = 14, 2006: n = 11).Ventilatory support was started at a median age of 1.8 years and continued for 13 months. Eleven (32.4%) patients received invasive mechanical ventilation via tracheostomy and 23 (67.6%) patients received noninvasive mechanical ventilation. Sixteen children (47.1%) were on noninvasive mechanical ventilation via nasal mask while 7 (20.6%) used a face mask. Seven (20.6%) patients received ventilatory support for 24 h and 27 (79.4%) patients were supported only during sleep. Twenty-four (70.6%) children received supplemental oxygen in addition to ventilatory support. Three patients successfully came off ventilatory support; 11 patients died during follow-up. None of the patients had home nursing and there were no life-threatening complications. Conclusions: A rapidly rising trend of HMV use in chronic respiratory failure (CRF) has been observed in this study. HMV can be safely applied in selected children with CRF with close monitoring and proper follow-up in developing countries despite the lack of home nursing.

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“…IMITED DATA SUPPORT THE current practices of tracheostomy tube (TT) care in children, including reuse of tubes, frequency of tube changes, and disinfection methods, 1 and there is a wide variation of practices based on physician preferences and availability of resources. 2 To our knowledge, the efficacy of household disinfection methods commonly used to reprocess pediatric TTs has never been evaluated. 3 Adequate cleaning of pediatric TTs is likely more challenging than adult ones because of the smaller diameter and absence of a removable inner cannula.…”

mentioning

confidence: 99%