1
|
Boyi T, Raghavan M, Antongiovanni J, DeGiovanni JC, Carr MM. Tracheotomy in children older than two years: Analysis of discharge trends from 2015 to 2020. Int J Pediatr Otorhinolaryngol 2024; 176:111815. [PMID: 38048732 DOI: 10.1016/j.ijporl.2023.111815] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/24/2023] [Revised: 11/20/2023] [Accepted: 11/29/2023] [Indexed: 12/06/2023]
Abstract
OBJECTIVE In light of increasingly complex patients being discharged with tracheostomies, we aimed to evaluate discharge trends over time in pediatric tracheotomy patients. We hypothesized that there would be delays in discharge from increased focus on preparing families for at-home care of critically ill pediatric patients. MATERIALS AND METHODS We conducted a cross-sectional analysis of pediatric patients who underwent tracheotomy (Current Procedural Terminology code 31600) between 2015 and 2020 using the American College of Surgeons National Surgical Quality Improvement Program Pediatric database (ACS NSQIP-P). Univariate and multivariate regression analyses were performed to assess patient demographics, comorbidities, perioperative factors, postoperative complications, and discharge information. Data were analyzed using Stata 15. RESULTS A total of 1552 patients were identified. There were 868 (56 %) males and 684 (44 %) females with a mean age of 7.3 ± 5.7 years. At least one comorbidity was seen in 1282 (83 %) patients, with 907 (58 %) having impaired cognitive status or developmental delay. Thirty-six (2.3 %) patients experienced mortality within 30 days, while 710 (46 %) were still in the hospital at 30 days. The odds of remaining in the hospital after 30 days were positively correlated with the year (p=.001). Other factors associated with an increased likelihood of remaining in the hospital after 30 days included younger patient age (p <.001), any complication (p <.001), and a higher American Society of Anesthesiologists classification (p <.001). CONCLUSION As years have progressed, fewer children were discharged from the hospital after 30 days following tracheotomy. Further research may identify socioeconomic factors contributing to the increasing length of hospital stays associated with a need for tracheotomy.
Collapse
Affiliation(s)
- Trinithas Boyi
- Department of Otolaryngology, University at Buffalo, Buffalo, NY, USA
| | - Maya Raghavan
- Department of Otolaryngology, University at Buffalo, Buffalo, NY, USA
| | - James Antongiovanni
- Elson S. Floyd College of Medicine, Washington State University, Spokane, WA, USA
| | | | - Michele M Carr
- Department of Otolaryngology, University at Buffalo, Buffalo, NY, USA.
| |
Collapse
|
2
|
Hysinger EB, Ahlfeld SK. Respiratory support strategies in the prevention and treatment of bronchopulmonary dysplasia. Front Pediatr 2023; 11:1087857. [PMID: 36937965 PMCID: PMC10018229 DOI: 10.3389/fped.2023.1087857] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2022] [Accepted: 02/02/2023] [Indexed: 03/06/2023] Open
Abstract
Neonates who are born preterm frequently have inadequate lung development to support independent breathing and will need respiratory support. The underdeveloped lung is also particularly susceptible to lung injury, especially during the first weeks of life. Consequently, respiratory support strategies in the early stages of premature lung disease focus on minimizing alveolar damage. As infants grow and lung disease progresses, it becomes necessary to shift respiratory support to a strategy targeting the often severe pulmonary heterogeneity and obstructive respiratory physiology. With appropriate management, time, and growth, even those children with the most extreme prematurity and severe lung disease can be expected to wean from respiratory support.
Collapse
Affiliation(s)
- Erik B. Hysinger
- Division of Pulmonary Medicine, Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH, United States
- Correspondence: Erik B. Hysinger
| | - Shawn K. Ahlfeld
- Division of Neonatology, Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH, United States
| |
Collapse
|
3
|
Poeppelman RS, Coles MT, Heater T, Vohsing L, Von Sadovszky V, Lutmer JE, Maa T. Assessing Competence With a Task Trainer: Validity Evidence for Novel Tracheostomy Care Skills Assessment Tool. Simul Healthc 2022; 17:220-225. [PMID: 34319269 DOI: 10.1097/sih.0000000000000597] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
INTRODUCTION The purpose of this study was to develop a caregiver and healthcare provider assessment tool to evaluate essential tracheostomy skills using a simulated task trainer. METHODS Three tracheostomy skill checklists were developed: closed suctioning, open suctioning, and tracheostomy change. Checklist items were developed based on institutional guidelines and a literature review. Items were revised based on iterative expert review and pilot testing. A total of 64 intensive care staff and 24 caregivers were evaluated using the checklists, of which 29 staff members and 4 caregivers were rated simultaneously by 2 raters to estimate interrater reliability. The relationships between checklist performance and staff demographics (experience and discipline) were calculated. A survey examining the selection of automatic fail items and minimum passing score was sent to 660 multidisciplinary staff members. RESULTS Intraclass correlations were 0.93 for closed suctioning, 0.93 for open suctioning, and 0.76 for tracheostomy change. Staff performance only correlated with experience for the tracheostomy change checklist and was inconsistently associated with discipline (respiratory therapy vs nursing). A large, multidisciplinary survey with 132 of 660 respondents confirmed the selection of automatic fail items and minimum passing score. A total of 92.9% of the survey respondents agreed with a minimum passing score of 80%. CONCLUSIONS We developed 3 essential tracheostomy skill checklists with multiple sources of validity evidence to support their use in a simulation-based assessment of tracheostomy skills.
Collapse
Affiliation(s)
- Rachel Stork Poeppelman
- From the University of Minnesota Masonic Children's Hospital (R.S.P.), Minneapolis, MN; and Nationwide Children's Hospital (M.T.C., T.H., L.V., V.V.S., J.E.L., T.M.), Ohio State University College of Medicine, Columbus, OH
| | | | | | | | | | | | | |
Collapse
|
4
|
Kerns AK, Mahoney R, Deeds K, Boone-Edwards K, Ross M, Siegel B. A Quality Improvement Plan for Implementing an Innovative Organization System for Pediatric Airway Patients. J Pediatr Intensive Care 2022; 11:120-123. [DOI: 10.1055/s-0040-1721381] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2020] [Accepted: 10/25/2020] [Indexed: 10/22/2022] Open
Abstract
AbstractRisks of pediatric tracheostomy are well known. The objectives of this quality improvement study were to organize tracheostomy supplies into a comprehensive care kit and demonstrate that the kits improved nursing and parental comfort in providing tracheostomy care routinely and emergently. Kits were assembled using roll-up toiletry style bags and organized in a uniform fashion with necessary supplies. Nurses and parents were surveyed using a 5-point Likert-type. Feedback was overall very positive; the kits were found to ease the transition of caring for a child with a new tracheostomy from hospital to home. This intervention can easily be adapted at other pediatric institutions.
Collapse
Affiliation(s)
- Aileen K. Kerns
- Department of Otolaryngology, Detroit Medical Center, Detroit, Michigan, United States
| | - Rebecca Mahoney
- Department of Otolaryngology, Detroit Medical Center, Detroit, Michigan, United States
| | - Kathryn Deeds
- Department of Pediatric Otolaryngology, Wayne State University, Detroit, Michigan, United States
| | - Keshia Boone-Edwards
- Department of Pediatric Otolaryngology, Children's Hospital of Michigan, Detroit, Michigan, United States
| | - Mary Ross
- Department of Pediatric Otolaryngology, Children's Hospital of Michigan, Detroit, Michigan, United States
| | - Bianca Siegel
- Department of Pediatric Otolaryngology, Wayne State University, Detroit, Michigan, United States
| |
Collapse
|
5
|
Kim HS, Kim GS, Lee H, Choi J, Kim YS, Oh EG. Effects of the Discharge Education Program on Family Caregivers Caring for Patients on Mechanical Home Ventilation in Korea: A Pilot Test. HOME HEALTH CARE MANAGEMENT AND PRACTICE 2022. [DOI: 10.1177/10848223221096344] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Patients on home ventilators rely on mechanical ventilation until their death; hence, family caregivers should perform additional caregiving, including tracheostomy, equipment management, and positive pressure ventilation by ambu-bag in emergencies. Therefore, a systematic discharge education program and evaluation of actual caregiver performance are necessary for safe home management. The program consists of suction and tracheostomy management, home ventilator management, emergency management, fundamental caregiving, and video material. To test clinical validity, family caregivers of patients about to be discharged to their homes from S hospital in Seoul, Korea, were selected by convenience sampling with a non-equivalent control group design. Of 18 participants, one refused, one died, and two became unstable after their agreement; therefore, 14 participants were finally included. To compare caregiving performance scores between the groups, we ran repeated measures ANOVA. Intergroup and period interaction of suction ( F = 6.08, p = .001) and tracheostomy management ( F = 3.00, p = .038) crucial for airway management, showed significant statistical differences. In short, the intervention group showed a faster increase in suction and tracheostomy management than the control group. Home ventilator management ( F = 22.53, p < .001), emergency management ( F = 12.01, p < .001), and fundamental caregiving ( F = 7.88, p < .001) showed significant differences within the group regarding the period. According to the results of the clinical validity test, the discharge education program increased the family caregiver’s suction and tracheostomy management performance scores. Further research is needed to demonstrate long-term effects of the program with a larger sample.
Collapse
Affiliation(s)
- Hyang Sook Kim
- College of Nursing, Yonsei University, Seoul, Republic of Korea
| | - Gwang Suk Kim
- Mo-Im Kim Nursing Research Institute, College of Nursing, Yonsei University, Seoul, Republic of Korea
| | - Hyangkyu Lee
- Mo-Im Kim Nursing Research Institute, College of Nursing, Yonsei University, Seoul, Republic of Korea
| | - JiYeon Choi
- Mo-Im Kim Nursing Research Institute, College of Nursing, Yonsei University, Seoul, Republic of Korea
| | - Young Sam Kim
- Department of Internal Medicine. Yonsei University Medical College Seoul, Republic of Korea
| | - Eui Geum Oh
- Mo-Im Kim Nursing Research Institute, College of Nursing, Yonsei University, Seoul, Republic of Korea
| |
Collapse
|
6
|
Shi JY, Orkin J, Walsh CM, Chu S, Keilty K, McKay S, Mocanu C, Qazi A, Ambreen M, Amin R. Pediatric Chronic Tracheostomy Care: An Evaluation of an Innovative Competency-Based Education Program for Community Health Care Providers. Front Pediatr 2022; 10:885405. [PMID: 35757113 PMCID: PMC9220937 DOI: 10.3389/fped.2022.885405] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2022] [Accepted: 05/05/2022] [Indexed: 11/27/2022] Open
Abstract
OBJECTIVE To evaluate the immediate and sustained knowledge retention and sense of self-efficacy of homecare nurses following completion of a standardized competency-based tracheostomy education course. Safe discharge of children requiring tracheostomy with or without ventilation relies on the competence of homecare nurses. STUDY DESIGN Pragmatic, randomized controlled trial of 44 homecare nurses. Participants were randomized into the intervention group (n = 21), which received the tracheostomy course, or the control group (n = 23), which received an enterostomy and vascular access course. Multiple-choice question (MCQ) knowledge assessments and self-efficacy questionnaires were administered to both groups pre-course and post-course at 6 week, 3 month, 6 month, and 12 month follow-ups. RESULTS Twenty participants in the intervention group and 19 in the control group were included. Four withdrew from the study and two crossed over from the control into the intervention arm. The change in mean self-efficacy scores (total score = 100) was significantly higher in the intervention group than in the control group at 6 weeks (intervention (mean ± SD): 18.6 ± 14.5; control: 6.6 ± 20.4; p = 0.04) and 3 months (intervention: 19.6 ± 14.2; control: 5.2 ± 17.0; p = 0.007), and trended higher at 6 months (intervention: 18.0 ± 14.5; control: 6.9 ± 24.1; p = 0.1). The change in mean MCQ assessment scores (total score = 20) trended higher in the intervention group than in the control group at 6 weeks (intervention (mean ± SD): 1.8 ± 2.2; control: 1.6, ± 2.9; p = 0.8). CONCLUSIONS Homecare nurses who attended the tracheostomy course demonstrated a higher sense of self-efficacy at long-term follow-up. CLINICAL TRIAL REGISTRATION www.ClinicalTrials.gov, identifier: NCT04559932.
Collapse
Affiliation(s)
- Jenny Y Shi
- Paediatric Respiratory Medicine, Hospital for Sick Children, University of Toronto, Toronto, ON, Canada
| | - Julia Orkin
- Complex Care Program, Hospital for Sick Children, University of Toronto, Toronto, ON, Canada
| | - Catharine M Walsh
- Division of Gastroenterology, Hepatology and Nutrition, Department of Paediatrics and the SickKids Research and Learning Institutes, Hospital for Sick Children, University of Toronto, Toronto, ON, Canada
| | - Stephanie Chu
- Connected Care, Hospital for Sick Children, University of Toronto, Toronto, ON, Canada
| | - Krista Keilty
- Connected Care, Hospital for Sick Children, University of Toronto, Toronto, ON, Canada
| | | | - Cora Mocanu
- Paediatric Respiratory Medicine, Hospital for Sick Children, University of Toronto, Toronto, ON, Canada
| | - Adam Qazi
- Paediatric Respiratory Medicine, Hospital for Sick Children, University of Toronto, Toronto, ON, Canada
| | - Munazzah Ambreen
- Paediatric Respiratory Medicine, Hospital for Sick Children, University of Toronto, Toronto, ON, Canada
| | - Reshma Amin
- Paediatric Respiratory Medicine, Hospital for Sick Children, University of Toronto, Toronto, ON, Canada
| |
Collapse
|
7
|
Abstract
For infants with the most severe forms of chronic lung disease, regardless of etiology, chronic mechanical ventilation can provide stability, reduce acute respiratory events, and alleviate increased work of breathing. This approach prioritizes the baby's growth and development during early life. Once breathing comfortably, these infants can tolerate developmental therapies with the goal of achieving the best neurocognitive outcomes possible.
Collapse
Affiliation(s)
- Christopher D Baker
- Section of Pulmonary and Sleep Medicine, Department of Pediatrics, University of Colorado School of Medicine, 13123 East 16th Avenue Box B-395, Aurora, CO 80045, USA.
| |
Collapse
|
8
|
Baker CD. Chronic respiratory failure in bronchopulmonary dysplasia. Pediatr Pulmonol 2021; 56:3490-3498. [PMID: 33666365 DOI: 10.1002/ppul.25360] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2020] [Revised: 02/27/2021] [Accepted: 03/01/2021] [Indexed: 11/09/2022]
Abstract
Although survival has improved dramatically for extremely preterm infants, those with the most severe forms of bronchopulmonary dysplasia (BPD) fail to improve in the neonatal period and go on to develop chronic respiratory failure. When careful weaning of respiratory support is not tolerated, the difficult decision of whether or not to pursue chronic ventilation via tracheostomy must be made. This requires shared decision-making with an interdisciplinary medical team and the child's family. Although they suffer from increased morbidity and mortality, the majority of these children will survive to tolerate ventilator liberation and tracheostomy decannulation. Care coordination for the technology-dependent preterm infant is complex, but there is a growing consensus that chronic ventilation can best support neurodevelopmental progress and improve long-term outcomes.
Collapse
Affiliation(s)
- Christopher D Baker
- Department of Pediatrics, Section of Pulmonary and Sleep Medicine, University of Colorado School of Medicine, Aurora, Colorado, USA
| |
Collapse
|
9
|
Pettitt-Schieber B, Mahendran G, Tey CS, Prickett KK. Risk factors for return visits in children discharged with tracheostomy. Int J Pediatr Otorhinolaryngol 2021; 150:110860. [PMID: 34403974 DOI: 10.1016/j.ijporl.2021.110860] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2021] [Revised: 06/11/2021] [Accepted: 07/27/2021] [Indexed: 10/20/2022]
Abstract
STUDY OBJECTIVES To determine associations between demographic and clinical characteristics and rate of unplanned returns to system (RTS) in pediatric patients discharged with tracheostomy. METHODS Medical records were examined for pediatric patients discharged after tracheostomy placement between January 1, 2011 and December 31, 2015. Exclusion criteria included death or decannulation prior to discharge and lack of follow-up through 180 days post-discharge. Readmissions were grouped by time interval after discharge (within 30 days or within 31-180 days). Chi-squared analysis and Fisher's Exact Test were utilized to determine associations between patient characteristics, rate and frequency of RTS, and type of admission (Emergency Department [ED] or inpatient [IP]). RESULTS One hundred twenty-one patients were eligible for the study, and 80 (66.1 %) had an unanticipated RTS during the follow-up period. Patients with early RTS had a higher total number of RTS. Patients with two or more RTS were more likely to be younger, while patients with five or more RTS were more likely to have greater organ system involvement and cardiovascular (CV) disease in particular. Patients presenting with GI diagnoses were more likely to be discharged from the ED. The rate of RTS remained constant throughout the time period examined. CONCLUSION Pediatric patients discharged with tracheostomy are medically complex and at high risk of RTS, especially for respiratory and GI problems. This risk does not decrease after the initial post-discharge period and long-term follow-up is warranted. Younger patients and patients with history of early RTS are at highest risk for repeat RTS and should be identified for closer outpatient care.
Collapse
Affiliation(s)
| | | | - Ching Siong Tey
- School of Medicine, Department of Pediatrics, Emory University, USA
| | - Kara K Prickett
- School of Medicine, Department of Pediatrics, Emory University, USA; School of Medicine, Department of Otolaryngology-Head and Neck Surgery, Emory University, USA.
| |
Collapse
|
10
|
Özcan G, Zirek F, Tekin MN, Bakirarar B, Çobanoğlu N. Risk factors for first nonscheduled hospital admissions of pediatric patients on home mechanical ventilation. Pediatr Pulmonol 2021; 56:3374-3379. [PMID: 34297898 DOI: 10.1002/ppul.25581] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2021] [Revised: 07/02/2021] [Accepted: 07/08/2021] [Indexed: 12/22/2022]
Abstract
OBJECTIVES The number of children on home mechanical ventilation (HMV) has increased. Understanding the reasons for nonscheduled hospital admissions during HMV is critical. This study aims to investigate the risk factors of first nonscheduled hospital admissions of pediatric patients on HMV. METHODS A retrospective analysis of patients on HMV between May 1, 2014 and October 1, 2020 was performed. Patients' demographic characteristics, duration of the education of the primary caregiver; time of first nonscheduled visit; and type of HMV (noninvasive mechanical ventilation [NIV] or invasive mechanical ventilation [IMV]) were analyzed. The reasons for first nonscheduled hospital visits were categorized as respiratory problems and other reasons. RESULTS Of 97 patients, 41 were female (42.3%), and 70 (72%) were on IMV. The median age was 23 months (IQR, 10-91). Twenty-nine patients (30%), were admitted to hospital before scheduled visit with a mean duration of 18.1 ± 11.6 days; of them, 14 (48.2%) admitted because of respiratory problems. IMV increases the risk of first nonscheduled visit compared to NIV (OR, 16.3; 95% CI, 2.1-127.4; p = .008). If a caregiver spends less than 14 days in hospital for education, risk of nonscheduled visits increases (OR, 4.0; 95% CI, 1.5-11.2; p = .007). CONCLUSION A minimum 14 days seems to be necessary for education of the caregivers of the patients with HMV to reduce the number of nonscheduled visits, which is a burden for both patients and healthcare system.
Collapse
Affiliation(s)
- Gizem Özcan
- Department of Pediatrics, Faculty of Medicine, Division of Pediatric Pulmonology, Faculty of Medicine, Ankara University, Ankara, Turkey
| | - Fazılcan Zirek
- Department of Pediatrics, Faculty of Medicine, Division of Pediatric Pulmonology, Faculty of Medicine, Ankara University, Ankara, Turkey
| | - Merve Nur Tekin
- Department of Pediatrics, Faculty of Medicine, Division of Pediatric Pulmonology, Faculty of Medicine, Ankara University, Ankara, Turkey
| | - Batuhan Bakirarar
- Department of Biostatistics, Faculty of Medicine, Ankara University, Ankara, Turkey
| | - Nazan Çobanoğlu
- Department of Pediatrics, Faculty of Medicine, Division of Pediatric Pulmonology, Faculty of Medicine, Ankara University, Ankara, Turkey
| |
Collapse
|
11
|
Neunhoeffer F, Miarka-Mauthe C, Harnischmacher C, Engel J, Renk H, Michel J, Hofbeck M, Hanser A, Kumpf M. Severe adverse events in children with tracheostomy and home mechanical ventilation - Comparison of pediatric home care and a specialized pediatric nursing care facility. Respir Med 2021; 191:106392. [PMID: 33865662 DOI: 10.1016/j.rmed.2021.106392] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2021] [Revised: 03/30/2021] [Accepted: 03/31/2021] [Indexed: 11/16/2022]
Abstract
BACKGROUND Advances in medical care and ventilator technologies increase the number of children with tracheostomy and home mechanical ventilation (HMV). Data on severe adverse events in home care and in specialized nursing care facilities are limited. PATIENTS AND METHODS Retrospective analysis of incidence and type of severe adverse events in children with tracheostomy and HMV in home care compared to a specialized nursing care facility over a 7-year period. RESULTS 163.9 patient-years in 70 children (home care: 110.7 patient-years, 24 patients; nursing care facility: 53.2 patient-years, 46 patients) were analyzed. In 34 (48.6%) patients tracheostomy was initiated at the age of <1 year. 35 severe adverse events were identified, incidence of severe adverse events per patient-year was 0.21 (median 0.0 (0.0-3.0)). We observed no difference in the rate of severe adverse events between home care and specialized nursing care facility (0.21 [y-1]; median 0.0 (0.0-3.0) versus 0.23 [y-1]; median 0.0 (0.0-1.6); p = 0.690), however, significantly more tracheostomy related incidents and infections occurred in the home care setting. Young age (<1 year) (Odds ratio 3.27; p = 0.045) and feeding difficulties (nasogastric tubes and percutaneous endoscopic gastrostomy) (Odds ratio 9.08; p = 0.016) significantly increased the risk of severe adverse events. Furthermore, the rate of severe adverse events was significantly higher in patients with a higher nursing score. CONCLUSION Pediatric home mechanical ventilation via tracheostomy is rarely associated with emergencies or adverse events in home care as well as in a specialized nursing care facility setting.
Collapse
Affiliation(s)
- Felix Neunhoeffer
- Department of Pediatric Cardiology, Pulmonology and Pediatric Intensive Care Medicine, University Children's Hospital, Hoppe-Seyler-Str. 1, 72076, Tuebingen, Germany.
| | - Christiane Miarka-Mauthe
- Arche IntensivKinder, Specialized Pediatric Nursing Care Facility, Bergstr. 36, 72127, Kusterdingen, Germany
| | - Cornelia Harnischmacher
- Department of Pediatric Cardiology, Pulmonology and Pediatric Intensive Care Medicine, University Children's Hospital, Hoppe-Seyler-Str. 1, 72076, Tuebingen, Germany
| | - Juliane Engel
- Department of Pediatric Cardiology, Pulmonology and Pediatric Intensive Care Medicine, University Children's Hospital, Hoppe-Seyler-Str. 1, 72076, Tuebingen, Germany
| | - Hanna Renk
- Department of Pediatric Cardiology, Pulmonology and Pediatric Intensive Care Medicine, University Children's Hospital, Hoppe-Seyler-Str. 1, 72076, Tuebingen, Germany
| | - Jörg Michel
- Department of Pediatric Cardiology, Pulmonology and Pediatric Intensive Care Medicine, University Children's Hospital, Hoppe-Seyler-Str. 1, 72076, Tuebingen, Germany
| | - Michael Hofbeck
- Department of Pediatric Cardiology, Pulmonology and Pediatric Intensive Care Medicine, University Children's Hospital, Hoppe-Seyler-Str. 1, 72076, Tuebingen, Germany
| | - Anja Hanser
- Department of Pediatric Cardiology, Pulmonology and Pediatric Intensive Care Medicine, University Children's Hospital, Hoppe-Seyler-Str. 1, 72076, Tuebingen, Germany
| | - Matthias Kumpf
- Department of Pediatric Cardiology, Pulmonology and Pediatric Intensive Care Medicine, University Children's Hospital, Hoppe-Seyler-Str. 1, 72076, Tuebingen, Germany
| |
Collapse
|
12
|
Nawaz RF, Page B, Harrop E, Vincent CA. Analysis of paediatric long-term ventilation incidents in the community. Arch Dis Child 2020; 105:446-451. [PMID: 31848150 PMCID: PMC7212935 DOI: 10.1136/archdischild-2019-317965] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/23/2019] [Revised: 10/30/2019] [Accepted: 10/31/2019] [Indexed: 01/16/2023]
Abstract
AIM To describe the nature and causes of reported patient safety incidents relating to care in the community for children dependent on long-term ventilation with the further aim of improving safety. METHODS We undertook an analysis of patient safety incident data relating to long-term ventilation in the community using incident reports from England and Wales' National Reporting and Learning System occurring between January 2013 and December 2017. Manual screening by two authors identified 220 incidents which met the inclusion criteria. The free text for each report was descriptively analysed to identify the problems in the delivery of care, the contributory factors and the patient outcome. RESULTS Common problems in the delivery of care included issues with faulty equipment and the availability of equipment, and concerns around staff competency. There was a clearly stated harm to the child in 89 incidents (40%). Contributory factors included staff shortages, out of hours care, and issues with packaging and instructions for equipment. CONCLUSIONS This study identifies a range of problems relating to long-term ventilation in the community, some of which raise serious safety concerns. The provision of services to support children on long-term ventilation and their families needs to improve. Priorities include training of staff, maintenance and availability of equipment, support for families and coordination of care.
Collapse
Affiliation(s)
- Rasanat Fatima Nawaz
- Department of Experimental Psychology, University of Oxford, Oxford, UK,Patient Safety Collaborative, Oxford Academic Health Science Network, Oxford, UK
| | - Bethan Page
- Department of Experimental Psychology, University of Oxford, Oxford, UK
| | | | - Charles A Vincent
- Department of Experimental Psychology, University of Oxford, Oxford, UK
| |
Collapse
|
13
|
Lawrence PR, Chambers R, Faulkner MS, Spratling R. Evidence-Based Care of Children With Tracheostomies: Hospitalization to Home Care. Rehabil Nurs 2020; 46:83-86. [PMID: 32108728 DOI: 10.1097/rnj.0000000000000254] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
ABSTRACT Routine tracheostomy care in children maintains airway patency, minimizes infection, and ensures skin integrity around the tracheostomy stoma to prevent complications. Using evidence-based recommendations for care of the mature tracheostomy limits variation in practice and leads to better patient outcomes in all care settings. Incorporating evidence-based care into practice is especially important because children with tracheostomies are at high risk for morbidity and mortality. The purpose of this review is to summarize the most current, evidence-based literature for pediatric tracheostomy care, including stoma care and tracheostomy suctioning. Rehabilitation nurses can then include these best practices when caring for children with tracheostomies and when educating caregivers who provide tracheostomy care to children at home.
Collapse
Affiliation(s)
- Patricia R Lawrence
- Byrdine F. Lewis College of Nursing and Health Professions, Georgia State University, Atlanta, GA, USA
| | | | | | | |
Collapse
|
14
|
Benscoter D, Borschuk A, Hart C, Voos K. Preparing families to care for ventilated infants at home. Semin Fetal Neonatal Med 2019; 24:101042. [PMID: 31648918 DOI: 10.1016/j.siny.2019.101042] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Advances in neonatal care have led to increased survival of infants with complex medical needs and technology dependence. Transition of the ventilator-dependent infant from hospital to home is a complex process that requires extensive coordination between the medical team and family. Home caregivers must be prepared to provide routine care for the ventilator-dependent child and respond to life-threatening emergencies. Families should be counseled on the need for home nursing, medical equipment and an adequate home environment to ensure a safe transition to home. Throughout the process, the family may require financial, social and psychological support. A structured education and transition process that is clearly communicated to parents is necessary to have an effective partnership with families.
Collapse
Affiliation(s)
- Dan Benscoter
- Department of Pediatrics, University of Cincinnati, College of Medicine, 3333 Burnet Ave, Cincinnati, 45229, OH, USA; Division of Pulmonary Medicine, Cincinnati Children's Hospital Medical Center, 3333 Burnet Ave, Cincinnati, 45229, OH, USA.
| | - Adrienne Borschuk
- Department of Pediatrics, University of Cincinnati, College of Medicine, 3333 Burnet Ave, Cincinnati, 45229, OH, USA; Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital Medical Center, 3333 Burnet Ave, Cincinnati, 45229, OH, USA.
| | - Catherine Hart
- Department of Otolaryngology, University of Cincinnati, College of Medicine, 231 Albert Sabin Way, Cincinnati, 45267, OH, USA.
| | - Kristin Voos
- Department of Pediatrics, Case Western Reserve University School of Medicine, 11100 Euclid Ave, Cleveland, 44106, OH, USA; Division of Neonatology, University Hospitals Cleveland Medical Center Rainbow Babies and Children's Hospital, 11100 Euclid Ave, Cleveland, 44106, OH, USA.
| |
Collapse
|
15
|
Abstract
PURPOSE OF REVIEW Modern medical advances have resulted in an increased survival after extremely preterm birth. However, some infants will develop severe bronchopulmonary dysplasia (BPD) and fail to wean from invasive or noninvasive positive pressure support. It remains unclear which infants will benefit from tracheostomy placement for chronic ventilation. Once the decision to pursue chronic ventilation has been made, questions remain with respect to the timing of tracheotomy surgery, optimal strategies for mechanical ventilation, and multidisciplinary care in both the inpatient and outpatient settings. The appropriate time for weaning mechanical ventilation and tracheostomy decannulation has similarly not been determined. RECENT FINDINGS Although there remains a paucity of randomized controlled trials involving infants with severe BPD, a growing body of evidence suggests that chronic ventilation via tracheostomy is beneficial to support the growth and development of severely affected preterm children. However, delivering such care is not without risk. Chronic ventilation via tracheostomy requires complex care coordination and significant resource utilization. SUMMARY When chronic respiratory insufficiency limits a preterm infant's ability to grow and develop, chronic invasive ventilation may facilitate neurodevelopmental progress and may lead to an improved long-term outcome.
Collapse
|