Tracheostomy in children: A population‐based experience over 17 years

Alsamri, Mohammed T.; Mitchell, Ian C.; Drummond, Derek; Bjornson, Candice

doi:10.1002/ppul.21206

Cited by 104 publications

(89 citation statements)

References 18 publications

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“…In 80% of cases the procedure became necessary after prolonged intubation in patients impossible to extubate [37], and generally at an early age (mean 1.8 years). These findings are consistent with the content of the national [5,6] and international [3,13,36] literature.…”

Section: Discussionsupporting

confidence: 80%

“…The percentage distribution of the various diseases and disorders in our sample was only partially consistent with other reports [1][2][3][4][5][6][7][8][10][11][12][13][31][32][33][34][35][36]: while the percentages relating to NMDs and CCHS were similar, there was a much lower rate of lung and airway diseases (bronchial dysplasia, malaria, ciliary dyskinesia, OSAS, and other respiratory diseases with chronic hypoventilation) in our sample, with 3.6% as opposed to 25-35% in the literature [1][2][3][4][5][6]8,9,[11][12][13][31][32][33][34][35][36]. This may relate to patient care and clinical or organizational factors particular to our setting: patients are only referred to the regional reference center if they are under 18 years old and have complex, lifethreatening diseases posing very complicated care issues.…”

Section: Discussionsupporting

confidence: 78%

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Long-Term Ventilation at Home and Pediatric Palliative Care: Patients’ Characterization in an Italian Regional Survey

Rusalen¹,

Agosto²,

Brugnaro³

et al. 2015

J Palliat Care Med

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Background: The prevalence of children receiving long-term mechanical ventilation at home (LTMV-H) is rising in many countries as advances in technology and medicine extend the survival of such patients. In Italy, the prevalence is 4.2 per 100,000 pediatric patients. It becomes essential to thoroughly assess these patients' needs, and of the quality and adequacy of their home care. Pediatric palliative care (PPC) may be an appropriate strategy for the global care and quality of life of children needing LTMV-H and their families.

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Section: Discussionsupporting

confidence: 80%

Section: Discussionsupporting

confidence: 78%

Long-Term Ventilation at Home and Pediatric Palliative Care: Patients’ Characterization in an Italian Regional Survey

Rusalen¹,

Agosto²,

Brugnaro³

et al. 2015

J Palliat Care Med

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“…Of the few articles that address the topic of tracheostomy-related wounds, the occurrence of wounds is mentioned, but specific treatments administered, duration of treatment, or recommendations are not described. [3][4][5][6][7] Although sponge and gauze barriers present viable solutions, the healing course is often lengthy and unpredictable and sometimes complete healing is not achieved. As these wounds lie in close proximity to the respiratory tract, it is important to also bear in mind the absorptive properties inherent in this region and to pay careful attention to the treatment options considered.…”

Section: Discussionmentioning

confidence: 99%

“…1,2 Many studies have looked at outcomes of tracheostomies, reporting on the mortality rates and major complications such as hemorrhage, dislodgement, and pneumothorax. [3][4][5] Only a few studies have included wound healing in their series of tracheostomy-related complications. 6 Regardless, wounds related to pediatric tracheostomies are common.…”

Section: Introductionmentioning

confidence: 99%

Enhanced Tracheostomy Wound Healing Using Maltodextrin and Silver Alginate Compounds in Pediatrics: A Pilot Study

et al. 2014

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BACKGROUND: Tracheostomy wounds are commonly encountered in children but rarely reported. Relatively few treatments are available or have been investigated to manage this problem. Healing times for pediatric tracheostomy wounds are often unpredictable and protracted. Recent use of maltodextrin gel (MD) and a silver alginate sponge (AG) at our institution has demonstrated expedited healing and interest in this novel treatment for tracheostomy wounds. METHODS: We conducted an 11-month retrospective review of children with wound complications following tracheostomy placement at a tertiary care facility. Wounds were evaluated and rated based upon the National Pressure Ulcer Advisory Panel staging system. Subjects identified with stage 2 or greater tracheostomy-related ulcers treated with MD and/or AG were included. Subject characteristics and wound healing rates were tabulated in a database that included age, wound site, initial and final wound stage, type of treatment, length of treatment, and complications. Tracheostomy wounds treated as an out-patient were excluded from the study. RESULTS: Eighteen subjects, which included both in-patients and out-patients, were treated with AG and/or MD during the study period for tracheostomy-related wounds. Of the 26 subjects with tracheostomies performed during the study period, 10 (38.5%) were treated for postoperative wounds. A total of 11 subjects completed their in-patient wound treatment and were thus included in the study. Average subject age was 5.3 y (range 0.25-15.6 y). Wound locations were as follows: infrastomal region (n ‫؍‬ 8), stoma (n ‫؍‬ 2), and lateral neck (n ‫؍‬ 1). Six subjects had stage 2 wounds, 4 had stage 3 wounds, and 1 had a stage 4 ulcer. All wounds achieved complete epithelialization following treatment with MD and/or AG. The average length of treatment was 12.8 d (range 6 -28 d). No adverse effects were identified. CONCLUSIONS: Postoperative tracheostomy wounds are common. The use of MD and AG provides an effective and safe treatment for tracheostomy-related ulcers.

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“…They are present on more than 90% of TTs within 7 days of insertion, and standard cleaning methods do not completely remove the bacteria 1, 2. Biofilms are associated with an increased risk of upper respiratory infections, TT occlusion, and wound infections by Staphylococcus and pseudomonas spp, among other complications 3, 4. They can also act as a source of chronic inflammation, leading to a cascade of granulation tissue, bleeding, TT obstruction, and difficulty maintaining airway patency 5, 6, 7…”

Section: Introductionmentioning

confidence: 99%

Effect of repeated tracheostomy tube reprocessing on biofilm formation

et al. 2015

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Objectives/HypothesisTo determine the effect of repeated reprocessing of pediatric tracheostomy tubes (TTs) on biofilm formation.Study DesignIn vitro microbiological study.MethodsPediatric, uncuffed, polyvinyl chloride (PVC) TTs from two different manufacturers (Tracoe Mini and Shiley) were reprocessed mechanically with household detergent and soaked in sodium hypochlorite (bleach). Two TTs of each brand were reprocessed 0 (control), 10, or 20 times. Twenty 2‐mm coupons were then obtained from each TT, immersed in human mucus, and cultured with either Staphylococcus aureus or Pseudomonas aeruginosa. Biofilm formation was evaluated with bacterial counts.ResultsBacterial counts of S. aureus for both brands were significantly higher on the TTs that were reprocessed 20 times compared to those that were not reprocessed (Tracoe: P = .040, Shiley: P < .0001) or those that were reprocessed 10 times (Tracoe: P = .022, Shiley: P = .0002). There was no difference between controls and TTs reprocessed 10 times (Tracoe: P = .76, Shiley: P = .24). P. aeuruginosa counts were not significantly different among the varying numbers of reprocessing cycles for either Tracoe or Shiley TTs (P = .08 and P = .97, respectively).ConclusionsRepeated reprocessing of PVC TTs with detergent and bleach paradoxically promotes S. aureus biofilm development, possibly due to degradation of the tube surface that facilitates bacterial attachment. Further investigation is needed to determine the optimal technique and limits of reprocessing TTs in clinical practice.Level of EvidenceNA Laryngoscope, 126:996–999, 2016

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Tracheostomy in children: A population‐based experience over 17 years

Cited by 104 publications

References 18 publications

Long-Term Ventilation at Home and Pediatric Palliative Care: Patients’ Characterization in an Italian Regional Survey

Long-Term Ventilation at Home and Pediatric Palliative Care: Patients’ Characterization in an Italian Regional Survey

Enhanced Tracheostomy Wound Healing Using Maltodextrin and Silver Alginate Compounds in Pediatrics: A Pilot Study

Effect of repeated tracheostomy tube reprocessing on biofilm formation

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