Pediatric Tracheostomy‐Related Complications: A Cross‐sectional Analysis

Newton, Micah; Johnson, Romaine F.; Wynings, Erin M.; Jaffal, Hussein; Chorney, Stephen R.

doi:10.1177/01945998211046527

Cited by 23 publications

(21 citation statements)

References 44 publications

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“…8 To date, much of what is known about post-tracheostomy mortality is limited to short-term studies. 4,9,10 Progression of underlying disease causes most deaths, but tracheostomy-related events can occur. 3,11,12 Analysis of mortality after pediatric tracheostomy can identify preventable outcomes that caregivers and institutions may anticipate.…”

Section: Introductionmentioning

confidence: 99%

“…The American Academy of Otolaryngology–Head and Neck Surgery Foundation (AAO‐HNSF) produced a clinical consensus statement on tracheostomy care to assist in minimizing complications, lowering length of stay, and reducing deaths after tracheostomy 8 . To date, much of what is known about post‐tracheostomy mortality is limited to short‐term studies 4,9,10 . Progression of underlying disease causes most deaths, but tracheostomy‐related events can occur 3,11,12 .…”

Section: Introductionmentioning

confidence: 99%

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Mortality Among Children with a Tracheostomy

et al. 2022

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Objectives To characterize the cause of death among children with a tracheostomy. Study Design Prospective cohort. Methods All pediatric patients (<18 years) who had a tracheostomy placed at a tertiary care institution between 2015 and 2020 were included. The location and cause of death were recorded along with patient demographics and age. Results A total of 271 tracheostomies were placed with 46 mortalities reviewed for a mortality rate of 16.8%. Mean age at placement was 1.7 years (SD: 3.4) and mean age at death was 2.9 years (SD: 3.5). Most tracheostomies were placed for respiratory failure (N = 33, 72%). The mean time to death after tracheostomy was 1.2 years (SD: 1.2) and 28% (N = 13) occurred during the same admission as placement. Mean time to death after hospital discharge was 1.3 years (SD: 1.3). Etiology of death was respiratory failure (33%, N = 15), cardiopulmonary arrest (15%, N = 7), unknown (43%, N = 20), or secondary to a tracheostomy‐related complication for 9% (N = 4). Location of death was in intensive care units for 41% (N = 19) and 30% died at home (N = 14). Comfort care measures were taken for 37% (N = 17). Severe neurological disability (HR: 4.06, p = 0.003, 95% CI: 1.59–10.34) and congenital heart disease (HR: 2.36, p = 0.009, 95% CI: 1.24–4.48) correlated with time to death on Cox proportional hazard modeling. Conclusions Nearly one‐third of children with a tracheostomy who expire will do so during the same admission as tracheostomy placement. Although progression of underlying disease will lead to most deaths, 9% will be a result of a tracheostomy‐related complication, which represents a meaningful target for quality improvement initiatives. Level of Evidence 3 Laryngoscope, 133:403–409, 2023

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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Mortality Among Children with a Tracheostomy

et al. 2022

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“…Complications significantly increase the mean cost and total charges burden on ICU patients and any attempt to mitigate complications benefits the patient as well as the healthcare system. 7 Early complications include bleeding, infection, subcutaneous emphysema, tube dislodgement, posterior tracheal wall injury, and tracheostomy tube obstruction. 8,9 The incidence of serious and fatal complications as well as readmission, however, is miniscule in comparison.…”

Section: Introductionmentioning

confidence: 99%

Retrospective Review of Acute Post-Tracheostomy Complications in Patients with Obstructive Pulmonary Diseases

Erickson

Katta

Sun

et al. 2022

Preprint

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Objective Tracheostomy is performed for various indications ranging from prolonged ventilation to airway obstruction. Many factors may play a role in the incidence of complications in the immediate post-operative period including patient-related factors. The relationship between obstructive pulmonary diseases and acute post-tracheostomy complications has been incompletely studied. Chronic obstructive pulmonary disease (COPD), obstructive sleep apnea (OSA), and asthma are some of the most common pulmonary pathologies in the United States and given the clinical utility of tracheostomies among these patients, it is important to characterize the risk of acute post-operative complications. Design A retrospective chart review identified tracheostomy patients from January 2017 through December 2018 at an academic cancer center. Medical records were reviewed for the technique used, complications, and contributing patient factors. Post-operative complications were defined as any tracheostomy-related adverse event occurring within 14 days. Patient factors examined included demographics, comorbidities, and body mass index (BMI). Results The most common indication for tracheostomy among the 321 patients that met inclusion criteria was airway obstruction or a head and neck cancer surgical procedure. Obstructive pulmonary pathology (COPD, OSA, asthma) was moderately associated with acute complications in bivariate analysis (13.4% complications, p = 0.039). Among the secondary outcomes measured, radiation was associated with early complications occurring in post-operative days 0-6 (1.1%, p = 0.029). Conclusion Obstructive pulmonary patients may have a higher risk of acute post-tracheostomy complications which is clinically significant when considering the utility of ventilation and tracheostomy in the management of acute respiratory failure secondary to these conditions.

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“…Although most complications are minor, including skin breakdown or granulomas, 6 major events such as bleeding, tube occlusion, accidental decannulations (AD), and death can occur 3,6 . These significant postoperative complications, though rare, contribute to an all‐cause early mortality rate of 7.4%–8.6% among pediatric tracheostomy patients 7,10,11 …”

Section: Introductionmentioning

confidence: 99%

“…Complications after pediatric tracheostomy will eventually occur in 16%-77% of children. [1][2][3][4][5][6] Nationwide estimates suggest that 8% of children will experience a tracheostomyrelated complication 7 with rates approaching 20% in singleinstitution series. 6,8,9 Although most complications are minor, including skin breakdown or granulomas, 6 major events such as bleeding, tube occlusion, accidental decannulations (AD), and death can occur.…”

Section: Introductionmentioning

confidence: 99%

Accidental Tracheostomy Decannulations in Children—A Prospective Cohort Study of Inpatients

et al. 2022

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Objectives: To determine the incidence of tracheostomy accidental decannulations (AD) among pediatric inpatients and identify risks for these events.Study Design: Prospective cohort. Methods: All tracheostomy patients (≤18 years) admitted at a tertiary children's hospital between August 2018 and April 2021 were included. AD were recorded and patient harm was classified as no harm/minor, moderate, or severe. Monthly AD incidence was described as events per 1000 tracheostomy-days.Results: One-hundred seventeen AD occurred among 67 children with 33% (22/67) experiencing multiple events (median: 2.5 events, range: 2-10). Mean age at AD was 4.7 years (SD: 4.4). AD resulted from patient movement (32%, 37/117), performing tracheostomy care (27%, 31/117), repositioning or transporting (15%, 17/117), or unclear reasons (27%, 32/117). A parent or guardian was involved in 28% (33/117) of events. Nearly all AD resulted in no more than minor harm (84%, 98/117) but moderate (12%, 14/117) and severe (4%, 5/117) events did occur. There were no deaths. Tracheostomy care or repositioning were frequently responsible in acute versus subacute events (48% vs. 26%, p = 0.04). Mean monthly AD incidence was 4.7 events per 1000 tracheostomy-days (95% CI: 3.7-5.8) and after implementation of safety initiatives, the mean rate decreased from 5.9 events (95% CI: 4.2-7.7) to 3.7 events (95% CI: 2.5-5.0) per 1000 tracheostomy-days (p = 0.04).Conclusions: AD in children occur at nearly 5 events per 1000 tracheostomy-days and often result in minimal harm. Quality initiatives targeting patient movement, provider education, and tracheostomy care might reduce the frequency of these complications.

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Pediatric Tracheostomy‐Related Complications: A Cross‐sectional Analysis

Cited by 23 publications

References 44 publications

Mortality Among Children with a Tracheostomy

Mortality Among Children with a Tracheostomy

Retrospective Review of Acute Post-Tracheostomy Complications in Patients with Obstructive Pulmonary Diseases

Accidental Tracheostomy Decannulations in Children—A Prospective Cohort Study of Inpatients

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