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Cherches A, Wang A, Patterson RH, Lee J, Cheng J. Preventing pediatric accidental decannulation events: A quality improvement initiative. Int J Pediatr Otorhinolaryngol 2024; 183:112052. [PMID: 39106759 DOI: 10.1016/j.ijporl.2024.112052] [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: 03/14/2024] [Revised: 07/22/2024] [Accepted: 07/26/2024] [Indexed: 08/09/2024]
Abstract
OBJECTIVE To describe a quality improvement (QI) method to decrease pediatric accidental decannulation (AD) in the early postoperative period for children under age 3. METHODS A retrospective chart review was conducted on children under age 3 who underwent tracheostomy at Duke University Health System from August 1, 2013 to May 1, 2023 (n = 104). A root cause analysis was used to assess factors associated with AD following pediatric tracheostomy. Based on the factors identified by the research team, retrospective data was collected before (8/1/13 - 1/31/22) and after (2/1/22 - 5/1/23) a single practice change was implemented: using twill neck ties, rather than foam neck ties, to secure newly-placed tracheostomy tubes. Twill ties were applied intraoperatively as a visual cue to signal a recent tracheostomy for the interdisciplinary care team. The primary outcome in the pre-intervention and post-intervention period was measured as 30-day incidence of AD per 10 tracheostomy cases. RESULTS Prior to the intervention, a total of 11 ADs occurred in 9 patients across 93 pediatric tracheostomies (1.18 AD per 10 cases). Afterward, 0 ADs occurred across 11 pediatric tracheostomies (0 AD per 10 cases). CONCLUSION This data suggests that the twill tie intervention may prevent AD and the associated morbidity. With the twill tie initiative, we describe 11 ADs and associated risk factors and present a QI intervention that may help prevent AD and improve patient safety in the early postoperative period.
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Affiliation(s)
- Alexander Cherches
- Duke University School of Medicine, Durham, NC, USA; Department of Otolaryngology - Head & Neck Surgery, University of Colorado, Aurora, CO, USA.
| | - Avivah Wang
- Duke University School of Medicine, Durham, NC, USA
| | - Rolvix H Patterson
- Department of Head and Neck Surgery & Communication Sciences, Duke University Medical Center, Durham, NC, USA; Hubert-Yeargan Center for Global Health, Duke University, Durham, NC, USA
| | - Janet Lee
- Department of Head and Neck Surgery & Communication Sciences, Duke University Medical Center, Durham, NC, USA
| | - Jeffrey Cheng
- Department of Head and Neck Surgery & Communication Sciences, Duke University Medical Center, Durham, NC, USA
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2
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Ergun E, Gollu G. Management of surgical problems in children on home invasive mechanical ventilation. Pediatr Pulmonol 2024; 59:2089-2095. [PMID: 38353339 DOI: 10.1002/ppul.26896] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2023] [Revised: 01/22/2024] [Accepted: 01/24/2024] [Indexed: 07/27/2024]
Abstract
The management of surgical problems in children on home invasive mechanical ventilation (HIMV) requires a comprehensive and multidisciplinary approach. HIMV is a critical intervention for children with chronic respiratory failure, as it allows them to live at home with their families while receiving life-sustaining ventilatory support. However, the long-term use of HIMV exposes these children to potential surgical complications related to their underlying conditions, tracheostomy tubes, ventilator devices, and gastrostomy tubes for enteral feeding. This manuscript aims to provide a detailed overview of the identification and recognition of surgical problems in children on HIMV, as well as strategies to solve these problems effectively.
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Affiliation(s)
- Ergun Ergun
- Department of Pediatric Surgery, Ankara University Faculty of Medicine, Ankara, Turkey
| | - Gulnur Gollu
- Department of Pediatric Surgery, Ankara University Faculty of Medicine, Ankara, Turkey
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Lakoff A, Beckford J, Charbonneau C, Lepine S, Lawrence SL. Supporting Direct Breastfeeding for a Tracheostomy-Dependent Extremely Premature Infant: A Case Study. J Hum Lact 2024; 40:419-424. [PMID: 38836434 DOI: 10.1177/08903344241254342] [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] [Indexed: 06/06/2024]
Abstract
INTRODUCTION The benefits of human milk for preterm infants are well documented. Complex medical conditions can limit the extremely premature infant's ability to breastfeed and to receive human milk directly, yet these vulnerable infants may benefit most from receiving it. MAIN ISSUE Extremely preterm infants are at risk for infections, digestive challenges, and chronic lung disease, and occasionally require a tracheostomy to facilitate weaning from mechanical ventilation. There is a risk of aspiration when orally feeding a child with a tracheostomy. This case study describes a tertiary neonatal team supporting a family's direct breastfeeding goal in an extremely premature infant with a diagnosis of bronchopulmonary dysplasia requiring a tracheostomy. MANAGEMENT Initially, the infant participant (born at 24 weeks and 3 days of gestation, with a birthweight of 540 g) was gavage fed with human milk. The interdisciplinary team collaborated with the family to guide the infant's feeding goals, providing positive oral stimulation with soothers, oral immune therapy, and frequent skin-to-skin contact to prepare for future oral feeding. Within a month of the tracheotomy procedure, oral feeding was initiated, and direct breastfeeding with the tracheostomy tubing in place was achieved at 50 weeks and 1 day of age as a primary source of nutrition. CONCLUSION The open dialogue between the family and healthcare team was the foundation for trialing direct breastfeeding for an extremely premature infant with a tracheostomy. While direct breastfeeding of full-term infants with tracheostomies has been previously described in the literature, this is the first case study of an extremely premature infant with a tracheostomy transitioning to direct breastfeeding.
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Affiliation(s)
| | | | | | - Susan Lepine
- Children's Hospital of Eastern Ontario, ON, Canada
| | - Sarah L Lawrence
- Children's Hospital of Eastern Ontario, ON, Canada
- The Ottawa Hospital, ON, Canada
- The Ontario Hospital
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Willis LD. Pediatric Tracheostomy Year in Review. Respir Care 2024; 69:1025-1032. [PMID: 38626953 PMCID: PMC11298220 DOI: 10.4187/respcare.11932] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/26/2024]
Abstract
Tracheostomized children have higher mortality compared to adults due to smaller airway anatomy and greater medical complexity and are at high risk for life-threatening complications. Following new tracheostomy placement, caregivers are required to successfully complete extensive training before discharge home. Training for tracheostomy emergencies such as tube obstruction and accidental decannulation is challenging without real-life, hands-on experience, but simulation training has shown promising effects on improving caregiver knowledge and comfort in preparing for emergency situations. Readmissions and emergency department visits are common following discharge, with many due to respiratory illness. Inhaled antibiotics are frequently prescribed to treat bacterial respiratory infection. However, guidelines for standardized management of tracheostomy-related respiratory illness are not available. Although standardized decannulation protocols are utilized, evidence-based guidelines are lacking, and the role of routine polysomnogram prior to decannulation is unresolved. Several knowledge gaps in management of pediatric tracheostomy present the opportunity for future research to improve patient outcomes.
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Affiliation(s)
- L Denise Willis
- Respiratory Care Services, Arkansas Children's Hospital, Little Rock, Arkansas
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5
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Song S, Louis Okoro O. Multidisciplinary Management of a Pediatric Patient With Congenital Anomalies Syndrome Without an Identified Genetic Mutation. Cureus 2024; 16:e64530. [PMID: 39139328 PMCID: PMC11321745 DOI: 10.7759/cureus.64530] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/11/2024] [Indexed: 08/15/2024] Open
Abstract
Congenital anomalies syndrome without an identified genetic mutation often presents significant challenges in pediatric care, requiring coordinated efforts across multiple specialties. This case reports a 10-year-old female patient with complex medical conditions, which exemplifies the intricate nature of managing children, necessitating long-term follow-up and comprehensive care. This case report aims to provide an in-depth analysis of her medical journey, including various interventions like tracheostomy and G-tube placement, and management strategies employed to address her congenital anomalies and associated health issues.
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Affiliation(s)
- Sungmin Song
- Medicine, Trinity School of Medicine, Warner Robins, USA
| | - Obioha Louis Okoro
- Pediatrics, Central Georgia Pediatrics, Georgia, USA
- Pediatrics, Piedmont Macon Medical Center, Georgia, USA
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6
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Komori M. Update on pediatric tracheostomy. Auris Nasus Larynx 2024; 51:429-432. [PMID: 38520972 DOI: 10.1016/j.anl.2024.01.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2023] [Revised: 12/30/2023] [Accepted: 01/12/2024] [Indexed: 03/25/2024]
Abstract
Pediatric tracheostomy has been widely performed since the 1800s, and in recent years, with advances in neonatal medicine, it has been performed at younger ages, starting at 0. In addition, advances in surgical techniques and postoperative tube management have reduced complications. This review will discuss the entire process of pediatric tracheostomy, starting with the history of tracheostomy and ending with indications, contraindications, techniques (slit, Björk, EXIT), complications, tube management, and decannulation. Pediatric tracheostomy patients require long-term care and management as they grow after the surgery itself, so otolaryngologists and pediatric tracheostomists are particularly involved in tube management and decannulation. We believe that sharing this information with all healthcare professionals will lead to better care for children with tracheostomies.
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Affiliation(s)
- Manabu Komori
- Department of Otolaryngology, St. Marianna University School of Medicine, 2-16-1 Sugao, Miyamae-ku, Kawasaki-city, Kanagawa, Japan.
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Murphy Salem SL, Perez JM, Staffa SJ, Duncan CN, Graham RJ. Outcomes for Pediatric Oncology and Hematopoietic Stem Cell Transplantation Patients Who Undergo Tracheostomy Placement: A Pediatric Health Information System Database Cohort Study, 2009-2020. Pediatr Crit Care Med 2024; 25:e283-e290. [PMID: 38452183 DOI: 10.1097/pcc.0000000000003478] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/09/2024]
Abstract
OBJECTIVES To describe the epidemiology, surgical complications, and long-term outcomes after tracheostomy in pediatric oncology and/or hematopoietic stem cell transplantation (HSCT) patients in U.S. Children's Hospitals. DESIGN Retrospective cohort from the Pediatric Health information System (PHIS) database, 2009-2020. SETTING The PHIS dataset incorporates data from 48 pediatric hospitals in the Children's Hospital Association. PATIENTS Patients 0-21 years old with an oncologic diagnosis and/or underwent HSCT, received a tracheostomy, and were discharged from hospital between January 1, 2009, and December 31, 2020. INTERVENTIONS None. MEASUREMENTS AND MAIN RESULTS There were 1061 patients included in the dataset, and 217 (20.5%) had undergone HSCT. The annual prevalence in tracheostomy usage did not change over the study period. The majority of patients (62.2%) underwent tracheostomy early (< 30 d) in the admission and those who underwent the procedure later (> 90 d) had a significant increase in mortality (52.6% vs. 17.6%; p < 0.001) and mechanical ventilation (MV) at discharge (51.9% vs. 24.5%; p < 0.001) compared with the early tracheostomy patients. Complications reported included tracheostomy site bleeding (< 1%) and infection (24%). The overall rate of MV at discharge was 32.6% and significantly associated with chronic lung (adjusted odds ratio [OR], 1.54; 95% CI, 1.03-2.32) and acute lung disease (OR, 2.18; 95% CI, 1.19-3.98). The overall rate of mortality was 19.6% within the cohort and significantly associated with HSCT (OR, 5.45; 95% CI, 3.88-7.70), diagnosis of sepsis (OR, 2.09; 95% CI, 1.28-3.41), and requirement for renal replacement therapy (OR, 2.76; 95% CI, 1.58-4,83). CONCLUSIONS This study demonstrated a static prevalence of tracheostomy placement in the cohort population relative to the increasing trends in other reported groups. Regardless of underlying diagnosis, the study patients incurred substantial morbidity and mortality. However, tracheostomy specific complication rates were comparable with that of the general pediatric population and were not associated with increased odds of mortality within this population.
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Affiliation(s)
- Sinead L Murphy Salem
- Department of Anesthesiology, Perioperative and Pain Medicine, Boston Children's Hospital, Boston, MA
| | - Jennifer M Perez
- Department of Anesthesiology, Perioperative and Pain Medicine, Boston Children's Hospital, Boston, MA
| | - Steven J Staffa
- Department of Anesthesiology, Perioperative and Pain Medicine, Boston Children's Hospital, Boston, MA
| | - Christine N Duncan
- Department of Hematology and Oncology, Boston Children's Hospital, Boston, MA
- Department of Pediatric Oncology, Dana-Farber Cancer Institute, Boston, MA
| | - Robert J Graham
- Department of Anesthesiology, Perioperative and Pain Medicine, Boston Children's Hospital, Boston, MA
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Edwards L, McRae J. Transitions in tracheostomy care: from childhood to adulthood. Curr Opin Otolaryngol Head Neck Surg 2024; 32:172-177. [PMID: 37548524 DOI: 10.1097/moo.0000000000000919] [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: 08/08/2023]
Abstract
PURPOSE OF REVIEW The purpose of this review is to explore the evidence around children and young people who require a tracheostomy and transition into adult services, reflecting on the challenges and considerations for clinical practice as these needs increase. RECENT FINDINGS There are a lack of data on the incidence and prevalence of children and young people with a tracheostomy transitioning to adult services for ongoing care. There are significant variations in care needs, technology and previous experiences that demand more than a simple handover process. Examples of service models that support the transition of care exist, however these lack specificity for children and young people with a tracheostomy. SUMMARY Further exploration of the needs of children and young people requiring airway technology is indicated, particularly considering the short and long-term education, health, and social care needs.
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Affiliation(s)
| | - Jackie McRae
- Centre for Allied Health, St George's University of London
- University College Hospitals NHS Foundation Trust, London, UK
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Viaud-Murat EM, Bahra L, Redmann AJ, Buck LS, Carratola M. Ethics in Practice: Laryngotracheoplasty Versus Tracheostomy in a Patient With Severe Hydranencephaly. Otolaryngol Head Neck Surg 2024; 170:1474-1477. [PMID: 38353287 DOI: 10.1002/ohn.680] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2023] [Revised: 11/21/2023] [Accepted: 12/01/2023] [Indexed: 04/30/2024]
Affiliation(s)
| | - Luka Bahra
- Department of Otolaryngology, University of Colorado Anschutz Medical Campuus, Parker, Colorado, USA
| | - Andrew J Redmann
- Department of Otolaryngology, Head and Neck Surgery, University of Minnesota, Minneapolis, Minnesota, USA
| | - Lauren S Buck
- Department of Otolaryngology, Head and Neck Surgery, Louisiana State University Health Sciences Center, Our Lady of the Lake Children's Hospital, Baton Rouge, Louisiana, USA
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Mazur L, Veten A, Ceneviva G, Pradhan S, Zhu J, Thomas NJ, Krawiec C. Characteristics and Outcomes of Intrahospital Transfers from Neonatal Intensive Care to Pediatric Intensive Care Units. Am J Perinatol 2024; 41:e1613-e1622. [PMID: 37037202 DOI: 10.1055/s-0043-1768069] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/12/2023]
Abstract
OBJECTIVE Critically ill children may be transferred from the neonatal intensive care unit (NICU) to the pediatric intensive care unit (PICU) for further critical care, but the frequency and outcomes of this patient population are unknown. The aims of this study are to describe the characteristics and outcomes in patients transferred from NICU to PICUs. We hypothesized that a higher-than-expected mortality would be present for patients with respiratory or cardiovascular diagnoses that underwent a NICU to PICU transition and that specific factors (timing of transfer, illness severity, and critical care interventions) are associated with a higher risk of mortality in the cardiovascular group. STUDY DESIGN Retrospective analysis of Virtual Pediatric Systems, LLC (2011-2019) deidentified cardiovascular and respiratory NICU to PICU subject data. We evaluated demographics, PICU length of stay, procedures, disposition, and mortality scores. Pediatric Index of Mortality 2 (PIM2) score was utilized to determine the standardized mortality ratio (SMR). RESULTS SMR of 4,547 included subjects (3,607 [79.3%] cardiovascular and 940 [20.7%] respiratory) was 1.795 (95% confidence interval: 1.62-1.97, p < 0.0001). Multivariable logistic regression analysis demonstrated transfer age (cardiovascular: odds ratio, 1.246 [1.10-1.41], p = 0.0005; respiratory: 1.254 [1.07-1.47], p = 0.0046) and PIM2 scores (cardiovascular: 1.404 [1.25-1.58], p < 0.0001; respiratory: 1.353 [1.08-1.70], p = 0.0095) were significantly associated with increased odds of mortality. CONCLUSION In this present study, we found that NICU to PICU observed deaths were high and various factors, particularly transfer age, were associated with increased odds of mortality. While the type of patients evaluated in this study likely influenced mortality, further investigation is warranted to determine if transfer timing is also a factor. KEY POINTS · NICU patients may be transitioned to the PICU.. · NICU to PICU observed deaths were high.. · Transfer timing may be a factor..
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Affiliation(s)
- Lauren Mazur
- Department of Pediatrics, Penn State College of Medicine, Hershey, Pennsylvania
| | - Ahmed Veten
- Department of Pediatrics, Pediatric Critical Care Medicine, Penn State Hershey Children's Hospital, Hershey, Pennsylvania
| | - Gary Ceneviva
- Department of Pediatrics, Pediatric Critical Care Medicine, Penn State Hershey Children's Hospital, Hershey, Pennsylvania
| | - Sandeep Pradhan
- Department of Public Health Sciences, Pennsylvania State University College of Medicine, Hershey, Pennsylvania
| | - Junjia Zhu
- Department of Public Health Sciences, Pennsylvania State University College of Medicine, Hershey, Pennsylvania
| | - Neal J Thomas
- Department of Pediatrics, Pediatric Critical Care Medicine, Penn State Hershey Children's Hospital, Hershey, Pennsylvania
- Department of Public Health Sciences, Pennsylvania State University College of Medicine, Hershey, Pennsylvania
| | - Conrad Krawiec
- Department of Pediatrics, Pediatric Critical Care Medicine, Penn State Hershey Children's Hospital, Hershey, Pennsylvania
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11
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Pons-Tomàs G, Painamil RM, Campos SR, Arasa EP, Sanflorencio LP, Corredor LP, López IT. Characteristics of tracheostomized patients followed up by a Palliative Care and Complex Chronic Patient Service. An Pediatr (Barc) 2024; 100:251-258. [PMID: 38604934 DOI: 10.1016/j.anpede.2024.03.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2023] [Accepted: 12/13/2023] [Indexed: 04/13/2024] Open
Abstract
INTRODUCTION AND OBJECTIVES In recent years, there has been an increase in the number of children with tracheostomies. The objective was to describe the characteristics of paediatric patients with a tracheostomy followed up by the Department of Palliative Care and Chronic Medically Complex Illness (DPCCMCI) of a tertiary care hospital. METHODS Single-centre retrospective observational study in patients aged less than 18 years with a tracheostomy followed up by the PCCCPS of a tertiary care hospital (November 2020-June 2022). We analysed epidemiological, clinical, microbiological and social data by reviewing the health records. RESULTS The sample included 44 tracheostomized patients. The most frequent underlying disease was acquired upper airway disease (20.5%). The most common indication for tracheostomy was upper airway obstruction (66%). Bacterial isolates were detected in 84% of the tracheal aspirates, among which P. aeruginosa was the most frequent (56.8%). The most frequently prescribed antibiotic was ciprofloxacin (84%). In addition, 18.1% of the patients received at least 1 course of intravenous antibiotherapy and 29.5% received more than 3 systemic antibiotic regimens in the past 20 months. Fifty-nine percent of the children were schooled: 38.6% attended a regular school, 15.9% a special needs school and 4.5% were home-schooled. We identified social difficulties in 53.7%. Also, 22.7% of the families received financial support to care for a child with severe illness. CONCLUSIONS Because of the complexity of caring for tracheostomized children, integral and coordinated management is essential. Schooling is possible and safe if caregivers are trained.
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Affiliation(s)
- Gemma Pons-Tomàs
- Servicio de Pediatría, Hospital Sant Joan de Déu, Barcelona, Spain
| | | | - Sílvia Ricart Campos
- Servicio de Pediatría, Hospital Sant Joan de Déu, Barcelona, Spain; Servicio de Atención Paliativa y Paciente crónico Complejo (C2P2), Hospital Sant Joan de Déu, Barcelona, Spain; Institut de Recerca Sant Joan de Déu, Barcelona, Spain
| | - Eduard Pellicer Arasa
- Servicio de Pediatría, Hospital Sant Joan de Déu, Barcelona, Spain; Institut de Recerca Sant Joan de Déu, Barcelona, Spain
| | - Lucía Peñarrubia Sanflorencio
- Servicio de Atención Paliativa y Paciente crónico Complejo (C2P2), Hospital Sant Joan de Déu, Barcelona, Spain; Institut de Recerca Sant Joan de Déu, Barcelona, Spain
| | - Laura Ponce Corredor
- Servicio de Atención Paliativa y Paciente crónico Complejo (C2P2), Hospital Sant Joan de Déu, Barcelona, Spain; Institut de Recerca Sant Joan de Déu, Barcelona, Spain
| | - Isabel Torrús López
- Servicio de Pediatría, Hospital Sant Joan de Déu, Barcelona, Spain; Servicio de Atención Paliativa y Paciente crónico Complejo (C2P2), Hospital Sant Joan de Déu, Barcelona, Spain; Institut de Recerca Sant Joan de Déu, Barcelona, Spain.
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12
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Song IG, Kim YS, Kim MS, Lee JW, Cho YM, Lim Y, Kwon SK, Suh DI, Park JD. Healthcare service use and medical outcomes of tracheostomy-dependent children: a nationwide study. BMJ Paediatr Open 2024; 8:e002377. [PMID: 38508660 PMCID: PMC10952918 DOI: 10.1136/bmjpo-2023-002377] [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: 11/08/2023] [Accepted: 03/10/2024] [Indexed: 03/22/2024] Open
Abstract
BACKGROUND Despite the rising trend of tracheostomies in children, there is a lack of comprehensive resources for families to navigate the challenges of living with a tracheostomy, emphasising the need for evidence-based support in understanding postoperative care and long-term adjustments. This study aimed to examine the pattern of using healthcare services and nationwide medical outcomes in children who underwent a tracheotomy before the age of 2 years. METHODS This retrospective study used the National Health Insurance System database from 2008 to 2016 and included all children codified with tracheotomy procedure codes before their second birthday. Healthcare utilisation, such as medical costs, number of hospital visits, home healthcare nursing and medical diagnoses on readmission, in the first 2 years after tracheotomy was evaluated. Multivariable logistic regression analysis was used to determine the factors affecting mortality. RESULTS In total, 813 patients were included in this study. Their use of healthcare services and the accompanying expenses were higher than the national medians for similar age groups; however, both metrics decreased in the second year. The major causes of admission within 2 years of surgery were respiratory and neurological diseases. The mortality rate within 2 years was 37.8%. Higher risks of mortality were associated with having two or more complex chronic conditions. Use of home healthcare nursing services was associated with a lower mortality risk. CONCLUSION Paediatric patients with more complex chronic conditions tended to have higher mortality rates within 2 years after surgery. However, receiving home healthcare nursing was significantly associated with a reduced risk of death. Many causes of hospitalisation may be preventable with education and supportive care. Therefore, further research for establishing an integrated care system for these patients and their caregivers is required.
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Affiliation(s)
- In Gyu Song
- Pediatrics, Yonsei University College of Medicine, Seodaemun-gu, Korea (the Republic of)
| | - You Sun Kim
- Department of Paediatrics, National Medical Center, Jung, Korea (the Republic of)
- Department of Paediatrics, Seoul National University College of Medicine, Seoul, Korea (the Republic of)
| | - Min Sun Kim
- Department of Paediatrics, Seoul National University College of Medicine, Seoul, Korea (the Republic of)
- Seoul National University Children's Hospital Integrated Care Center, Seoul, Korea (the Republic of)
| | - Ji Weon Lee
- Seoul National University Children's Hospital Integrated Care Center, Seoul, Korea (the Republic of)
| | - Yoon-Min Cho
- National Health Insurance Service, Wonju, Korea (the Republic of)
| | - Youna Lim
- Seoul National University, Gwanak-gu, Korea (the Republic of)
| | - Seong Keun Kwon
- Department of Otorhinolaryngology-Head and Neck Surgery, Seoul National University College of Medicine, Seoul, Korea (the Republic of)
| | - Dong In Suh
- Department of Paediatrics, Seoul National University College of Medicine, Seoul, Korea (the Republic of)
| | - June Dong Park
- Department of Paediatrics, Seoul National University College of Medicine, Seoul, Korea (the Republic of)
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Blancher A, Mamidi I, Morris L. Tongue and Mandibular Disorders of the Pediatric Patient. Facial Plast Surg Clin North Am 2024; 32:157-167. [PMID: 37981411 DOI: 10.1016/j.fsc.2023.08.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2023]
Abstract
Robin sequence, macroglossia, and ankyloglossia are disorders affecting the tongue and mandible in the pediatric population. Each of these can have a significant impact on breathing, feeding, speech, dentition, and craniofacial growth. This review discusses the interdependent and coordinated development of both the tongue and mandible, the functional impacts of these disorders, and appropriate management strategies.
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Affiliation(s)
- Adam Blancher
- Louisiana State University Health Sciences Center-New Orleans, Department of Otolaryngology-Head and Neck Surgery, 533 Bolivar Street Suite 566, New Orleans, LA 70112, USA
| | - Ishwarya Mamidi
- Louisiana State University Health Sciences Center-New Orleans, Department of Otolaryngology-Head and Neck Surgery, 533 Bolivar Street Suite 566, New Orleans, LA 70112, USA
| | - Lisa Morris
- Louisiana State University Health Sciences Center-New Orleans, Department of Otolaryngology-Head and Neck Surgery, 533 Bolivar Street Suite 566, New Orleans, LA 70112, USA.
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14
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Vo HH, Mercer AH, Jabre NA, Henderson CM, Boss RD, Wilfond BS. Parent Perspectives on the Child Experience of Pediatric Home Ventilation via Tracheostomy. Hosp Pediatr 2023; 13:1124-1133. [PMID: 37964652 DOI: 10.1542/hpeds.2023-007217] [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: 11/16/2023]
Abstract
BACKGROUND AND OBJECTIVE Parents facing the decision of whether to initiate pediatric mechanical ventilation via tracheostomy ("home ventilation") report wanting information about what to expect for life at home for their child. The study objective is to explore parent descriptions of the child experience of home ventilation to increase awareness for clinicians in the inpatient setting caring for these children. METHODS Semistructured interviews were conducted using purposive sampling of parents with children who initiated home ventilation within the previous 5 years from 3 geographically diverse academic medical centers. RESULTS We interviewed 21 families from 3 geographic regions in the United States. About 75% of children had respiratory failure in the first year of life, 80% had medical complexity, and half had severe neurologic impairment. Five domains emerged regarding parent perceptions of their child's experience of home ventilation: (1) health and well-being; (2) development; (3) adaptation; (4) mobility and travel; and (5) relationships. Within each domain, several themes were identified. For each theme, there was a positive and negative subtheme to illustrate how the child's experience was modified by home ventilation. Parent descriptions were generally positive, however, in all domains and to varying degrees, parents expressed negative aspects of home ventilation. CONCLUSIONS By providing information about the realistic experiences of children using home ventilation, clinicians can support families in the inpatient setting as they face this complex decision. Balanced information about home ventilation is critical to enhancing clinician counseling so that families may benefit from the perspectives of experienced parents.
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Affiliation(s)
- Holly Hoa Vo
- University of Washington School of Medicine, Seattle, Washington
- Treuman Katz Center for Pediatric Bioethics, Seattle Children's Research Institute, Seattle, Washington
| | - Amanda H Mercer
- Treuman Katz Center for Pediatric Bioethics, Seattle Children's Research Institute, Seattle, Washington
| | | | - Carrie M Henderson
- University of Mississippi Medical Center, Jackson, Mississippi
- Center for Bioethics and Medical Humanities, Jackson, Mississippi
| | - Renee D Boss
- Johns Hopkins School of Medicine, Baltimore, Maryland
- Johns Hopkins Berman Institute of Bioethics, Baltimore, Maryland
| | - Benjamin S Wilfond
- University of Washington School of Medicine, Seattle, Washington
- Treuman Katz Center for Pediatric Bioethics, Seattle Children's Research Institute, Seattle, Washington
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15
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Bathwal R, Dongol K, Dutta H, Neupane Y. Tracheostomy among Children Admitted in the Pediatric Intensive Care Unit of a Tertiary Care Centre. JNMA J Nepal Med Assoc 2023; 61:852-855. [PMID: 38289739 PMCID: PMC10725229 DOI: 10.31729/jnma.8323] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2023] [Indexed: 02/01/2024] Open
Abstract
Introduction Tracheostomy is commonly performed for upper airway obstruction, prolonged mechanical ventilation and tracheo-bronchial toileting. Pediatric tracheostomy differs from adult tracheostomy in terms of surgical procedure, post-operative care and recovery. The tracheostomized patients may either be decannulated, discharged with tube-in-situ or the patient may expire. The aim of this study was to find out the prevalence of tracheostomy in patients admitted to the Pediatric intensive care unit of a tertiary care centre. Methods A descriptive cross-sectional study was performed among children admitted to the Pediatric intensive care unit of a tertiary care centre from 1 May 2017 to 31 August 2022 after obtaining ethical approval from the Institutional Review Committee. A convenience sampling method was used. The point estimate was calculated at 95% Confidence Interval. Results Among 1472 patients, tracheostomy was done in 65 (4.41%) (3.37-5.47, 95% Confidence Interval). A total of 33 (50.76%) underwent tracheostomy for prolonged ventilation whereas 32 (49.23%) were tracheostomized for airway obstruction. Among them, 41 (63.07%) patients were successfully decannulated, 9 (13.84%) were discharged with tracheostomy tubes in situ whereas 15 (23.07%) patients deceased. The most common complication was tracheostomy tube blockage reported in 5 (7.69%). Conclusions The prevalence of tracheostomy among the children of the pediatric intensive care unit was found to be lower than in other studies. Keywords mechanical ventilation; complication; pediatric; tracheostomy.
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Affiliation(s)
- Rahul Bathwal
- Department of ENT-HNS, Tribhuvan University Teaching Hospital, Maharajgunj, Kathmandu, Nepal
| | - Kripa Dongol
- Department of ENT-HNS, Tribhuvan University Teaching Hospital, Maharajgunj, Kathmandu, Nepal
| | - Heempali Dutta
- Department of ENT-HNS, Tribhuvan University Teaching Hospital, Maharajgunj, Kathmandu, Nepal
| | - Yogesh Neupane
- Department of ENT-HNS, Tribhuvan University Teaching Hospital, Maharajgunj, Kathmandu, Nepal
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16
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Mirza B, Marouf A, Abi Sheffah F, Marghlani O, Heaphy J, Alherabi A, Zawawi F, Alnoury I, Al-Khatib T. Factors influencing quality of life in children with tracheostomy with emphasis on home care visits: a multi-centre investigation. J Laryngol Otol 2023; 137:1102-1109. [PMID: 36089743 DOI: 10.1017/s002221512200202x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
OBJECTIVE Only a few studies have assessed the quality of life in children with tracheostomies. This study aimed to evaluate the quality of life and the factors influencing it in these children. METHOD This cross-sectional, two-centre study was conducted on paediatric patients living in the community with a tracheostomy by using the Pediatric Quality of Life Inventory. Clinical and demographic information of patients, as well as parents' socioeconomic factors, were obtained. RESULTS A total of 53 patients met our inclusion criteria, and their parents agreed to participate. The mean age of patients was 6.85 years, and 21 patients were ventilator-dependent. The total paediatric health-related quality of life score was 59.28, and the family impact score was 68.49. In non-ventilator-dependent patients, multivariate analyses indicated that social functioning and health-related quality of life were negatively affected by the duration of tracheostomy. The Quality of Life of ventilator-dependent patients was influenced by care visits and the presence of pulmonary co-morbidities. CONCLUSION Children with tracheostomies have a lower quality of life than healthy children do. Routine care visits by a respiratory therapist and nurses yielded significantly improved quality of life in ventilator-dependent children.
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Affiliation(s)
- B Mirza
- Department of Otolaryngology - Head and Neck Surgery, Faculty of Medicine, King Abdulaziz University, Jeddah
| | - A Marouf
- Department of Surgery, Otolaryngology - Head and Neck Surgery Section, King Faisal Specialist Hospital and Research Centre, Jeddah
| | - F Abi Sheffah
- Department of Surgery, Otolaryngology - Head and Neck Surgery Section, King Faisal Specialist Hospital and Research Centre, Jeddah
| | - O Marghlani
- Department of Surgery, Otolaryngology - Head and Neck Surgery Section, King Faisal Specialist Hospital and Research Centre, Jeddah
- Department of Otolaryngology - Head and Neck Surgery, College of Medicine, Umm Al-Qura University, Makkah, Saudi Arabia
| | - J Heaphy
- Department of Surgery, Otolaryngology - Head and Neck Surgery Section, King Faisal Specialist Hospital and Research Centre, Jeddah
| | - A Alherabi
- Department of Surgery, Otolaryngology - Head and Neck Surgery Section, King Faisal Specialist Hospital and Research Centre, Jeddah
- Department of Otolaryngology - Head and Neck Surgery, College of Medicine, Umm Al-Qura University, Makkah, Saudi Arabia
| | - F Zawawi
- Department of Otolaryngology - Head and Neck Surgery, Faculty of Medicine, King Abdulaziz University, Jeddah
| | - I Alnoury
- Department of Otolaryngology - Head and Neck Surgery, Faculty of Medicine, King Abdulaziz University, Jeddah
| | - T Al-Khatib
- Department of Otolaryngology - Head and Neck Surgery, Faculty of Medicine, King Abdulaziz University, Jeddah
- Department of Surgery, Otolaryngology - Head and Neck Surgery Section, King Faisal Specialist Hospital and Research Centre, Jeddah
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17
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Miller AN, Shepherd EG, Manning A, Shamim H, Chiang T, El-Ferzli G, Nelin LD. Tracheostomy in Severe Bronchopulmonary Dysplasia-How to Decide in the Absence of Evidence. Biomedicines 2023; 11:2572. [PMID: 37761012 PMCID: PMC10526913 DOI: 10.3390/biomedicines11092572] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2023] [Revised: 09/08/2023] [Accepted: 09/14/2023] [Indexed: 09/29/2023] Open
Abstract
Infants with the most severe forms of bronchopulmonary dysplasia (BPD) may require long-term invasive positive pressure ventilation for survival, therefore necessitating tracheostomy. Although life-saving, tracheostomy has also been associated with high mortality, postoperative complications, high readmission rates, neurodevelopmental impairment, and significant caregiver burden, making it a highly complex and challenging decision. However, for some infants tracheostomy may be necessary for survival and the only way to facilitate a timely and safe transition home. The specific indications for tracheostomy and the timing of the procedure in infants with severe BPD are currently unknown. Hence, centers and clinicians display broad variations in practice with regard to tracheostomy, which presents barriers to designing evidence-generating studies and establishing a consensus approach. As the incidence of severe BPD continues to rise, the question remains, how do we decide on tracheostomy to provide optimal outcomes for these patients?
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Affiliation(s)
- Audrey N. Miller
- Comprehensive Center for Bronchopulmonary Dysplasia, Department of Pediatrics, Division of Neonatology, Nationwide Children’s Hospital, Ohio State University College of Medicine, Columbus, OH 43205, USA; (A.N.M.); (E.G.S.); (G.E.-F.)
| | - Edward G. Shepherd
- Comprehensive Center for Bronchopulmonary Dysplasia, Department of Pediatrics, Division of Neonatology, Nationwide Children’s Hospital, Ohio State University College of Medicine, Columbus, OH 43205, USA; (A.N.M.); (E.G.S.); (G.E.-F.)
| | - Amy Manning
- Department of Otolaryngology, Nationwide Children’s Hospital, Ohio State University College of Medicine, Columbus, OH 43205, USA; (A.M.); (H.S.); (T.C.)
| | - Humra Shamim
- Department of Otolaryngology, Nationwide Children’s Hospital, Ohio State University College of Medicine, Columbus, OH 43205, USA; (A.M.); (H.S.); (T.C.)
| | - Tendy Chiang
- Department of Otolaryngology, Nationwide Children’s Hospital, Ohio State University College of Medicine, Columbus, OH 43205, USA; (A.M.); (H.S.); (T.C.)
| | - George El-Ferzli
- Comprehensive Center for Bronchopulmonary Dysplasia, Department of Pediatrics, Division of Neonatology, Nationwide Children’s Hospital, Ohio State University College of Medicine, Columbus, OH 43205, USA; (A.N.M.); (E.G.S.); (G.E.-F.)
| | - Leif D. Nelin
- Comprehensive Center for Bronchopulmonary Dysplasia, Department of Pediatrics, Division of Neonatology, Nationwide Children’s Hospital, Ohio State University College of Medicine, Columbus, OH 43205, USA; (A.N.M.); (E.G.S.); (G.E.-F.)
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18
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Timing of Tracheostomy in Critically Ill Infants and Children With Respiratory Failure: A Pediatric Health Information System Study. Pediatr Crit Care Med 2023; 24:e66-e75. [PMID: 36508241 DOI: 10.1097/pcc.0000000000003120] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
OBJECTIVES Tracheostomy placement in infants and children with respiratory failure has steadily increased over time, yet there is no consensus for optimal timing. We sought to: 1) describe tracheostomy timing and associated demographic and clinical characteristics in a large ICU cohort and 2) compare clinical outcomes between subgroups based on tracheostomy timing. DESIGN Retrospective observational study using the Pediatric Health Information System (PHIS). SETTING Neonatal ICUs and PICUs in the United States. PATIENTS PHIS was queried for patients less than 18 years who underwent tracheostomy from 2010 to 2020. Patients were included if admitted to an ICU with need for mechanical ventilation (MV) prior to tracheostomy in the same hospitalization. Patients were categorized as early tracheostomy (ET) (placement at MV day ≤ 14), late tracheostomy (LT) (MV days 15-60), and extended tracheostomy (ExT) (MV day > 60). Primary endpoints included demographic and clinical characteristics. Secondary endpoints included patient outcomes: in-hospital mortality, length of stay (LOS), hospital-acquired pneumonia (HAP), and hospital costs. INTERVENTIONS None. MEASUREMENTS AND MAIN RESULTS Sixteen thousand one hundred twenty-one patients underwent tracheostomy at 52 children's hospitals. Ten thousand two hundred ninety-five had complete data and were included in the analysis. Thirty-nine percent (4,006/10,295) underwent ET, 40% (4,159/10,295) underwent LT, and 21% (2,130/10,295) underwent ExT. Majority of patients in all subgroups had complex chronic conditions. Median age was significantly different between subgroups with ET being the oldest ( p < 0.001). A multivariable regression analysis showed that ET was associated with lower in-hospital mortality ( p < 0.001), shorter hospital LOS ( p < 0.001), shorter ICU LOS ( p < 0.001), shorter post-tracheostomy LOS ( p < 0.001), decreased HAP ( p < 0.001), and lower hospital costs ( p < 0.001) compared with those who underwent LT or ExT. CONCLUSIONS In a large cohort of pediatric patients with respiratory failure, tracheostomy placement within 14 days of MV was associated with improved in-hospital outcomes. ET was independently associated with decreased mortality, LOS, HAP, and hospital costs.
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Richardson CM, Perkins JN, Zenner K, Bull C, Lutsky E, Jensen DM, Dmyterko V, Bennett JT, Wenger TL, Dahl JP, Bonilla-Velez J, Bly RA, Geddis AE, Perkins JA. Primary targeted medical therapy for management of bilateral head and neck lymphatic malformations in infants. Int J Pediatr Otorhinolaryngol 2023; 164:111371. [PMID: 36459725 PMCID: PMC10243723 DOI: 10.1016/j.ijporl.2022.111371] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2022] [Revised: 10/19/2022] [Accepted: 10/26/2022] [Indexed: 11/16/2022]
Abstract
OBJECTIVES Patients born with bilateral head and neck lymphatic malformations (BHNLMs) often require multiple invasive treatments, including tracheostomy. We hypothesized that primary targeted medical therapy (pTMT) with diagnostic needle aspiration reduces the need for invasive therapy such as surgical resection and/or sclerotherapy. METHODS Retrospective case review was performed of infants with BHNLMs (Grade 2 or De Serres stage IV and V) treated only at our institution from 2000 to 2021. Patients were divided into two cohorts: those managed with pTMT and those managed with observation, sclerotherapy, or surgical intervention (non-pTMT). Data regarding interventions, clinical outcomes, morbidity, and mortality were analyzed with descriptive statistics. RESULTS Nine children with BHNLMs met inclusion criteria. Three (33%) were in the pTMT cohort and six (66%) were non-pTMT. Eight (89%) malformations were genotyped, and all demonstrated hotspot PIK3CA variants. All pTMT patients had sirolimus initiated in the first month of life and underwent needle aspiration of malformation cyst fluid for cell-free DNA samples. All pTMT patients tolerated medical therapy. For the non-pTMT cohort, primary treatment included none (deceased, n = 1, 17%), observation with needle aspiration (n = 1, 17%), surgical resection (n = 2, 33%), or combination surgery and sclerotherapy (n = 2, 33%). Intubation duration, intensive care and initial hospital length of stay were not different between cohorts. Four non-pTMT patients (67%) required tracheostomy, and two (33%) died prior to discharge. All pTMT patients survived and none required tracheostomy. Non-pTMT patients required a median of two invasive therapies prior to discharge (IQR 1-4) and a mean total of 13 over the course of their lifetime (IQR 1-16), compared to the pTMT group who did not require any lifetime invasive therapy, even after initial pTMT and discharge home. CONCLUSION This study compares patients with BHNLMs (Grade 2) treated with pTMT versus those treated with observation or invasive therapy. Patients treated with pTMT required no surgical or invasive procedural treatment of their malformations, no tracheostomy placement, no unplanned readmissions after discharge, and had no mortalities. Needle aspiration was useful as a therapeutic adjunct for cell-free DNA diagnosis of PIK3CA variants, which guided TMT.
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Affiliation(s)
- Clare M Richardson
- Division of Otolaryngology - Head and Neck Surgery, Department of Surgery, Seattle Children's Hospital, MS OA.9.220, PO Box 5371, Seattle, WA, 98145, USA; Department of Otolaryngology - Head and Neck Surgery, University of Washington, 1959 NE Pacific St, Box 356515, Seattle, WA, 98195, USA.
| | - Jonathan N Perkins
- Division of Otolaryngology - Head and Neck Surgery, Department of Surgery, Seattle Children's Hospital, MS OA.9.220, PO Box 5371, Seattle, WA, 98145, USA; Department of Otolaryngology - Head and Neck Surgery, University of Washington, 1959 NE Pacific St, Box 356515, Seattle, WA, 98195, USA.
| | - Kaitlyn Zenner
- Department of Otolaryngology - Head and Neck Surgery, University of Washington, 1959 NE Pacific St, Box 356515, Seattle, WA, 98195, USA.
| | - Catherine Bull
- Division of Otolaryngology - Head and Neck Surgery, Department of Surgery, Seattle Children's Hospital, MS OA.9.220, PO Box 5371, Seattle, WA, 98145, USA.
| | - Erika Lutsky
- Division of Otolaryngology - Head and Neck Surgery, Department of Surgery, Seattle Children's Hospital, MS OA.9.220, PO Box 5371, Seattle, WA, 98145, USA.
| | - Dana M Jensen
- Center for Clinical and Translational Research, Seattle Children's Hospita, USAl.
| | - Victoria Dmyterko
- Center for Clinical and Translational Research, Seattle Children's Hospita, USAl.
| | - James T Bennett
- Center for Clinical and Translational Research, Seattle Children's Hospita, USAl; Division of Genetic Medicine, Department of Pediatrics, Seattle Children's Hospital, USA.
| | - Tara L Wenger
- Division of Genetic Medicine, Department of Pediatrics, Seattle Children's Hospital, USA.
| | - John P Dahl
- Division of Otolaryngology - Head and Neck Surgery, Department of Surgery, Seattle Children's Hospital, MS OA.9.220, PO Box 5371, Seattle, WA, 98145, USA; Department of Otolaryngology - Head and Neck Surgery, University of Washington, 1959 NE Pacific St, Box 356515, Seattle, WA, 98195, USA; Center for Clinical and Translational Research, Seattle Children's Hospita, USAl.
| | - Juliana Bonilla-Velez
- Division of Otolaryngology - Head and Neck Surgery, Department of Surgery, Seattle Children's Hospital, MS OA.9.220, PO Box 5371, Seattle, WA, 98145, USA; Department of Otolaryngology - Head and Neck Surgery, University of Washington, 1959 NE Pacific St, Box 356515, Seattle, WA, 98195, USA; Center for Clinical and Translational Research, Seattle Children's Hospita, USAl.
| | - Randall A Bly
- Division of Otolaryngology - Head and Neck Surgery, Department of Surgery, Seattle Children's Hospital, MS OA.9.220, PO Box 5371, Seattle, WA, 98145, USA; Department of Otolaryngology - Head and Neck Surgery, University of Washington, 1959 NE Pacific St, Box 356515, Seattle, WA, 98195, USA.
| | - Amy E Geddis
- Center for Clinical and Translational Research, Seattle Children's Hospita, USAl; Division of Hematology-Oncology, Department of Pediatrics, Seattle Children's Hospital, USA.
| | - Jonathan A Perkins
- Division of Otolaryngology - Head and Neck Surgery, Department of Surgery, Seattle Children's Hospital, MS OA.9.220, PO Box 5371, Seattle, WA, 98145, USA; Department of Otolaryngology - Head and Neck Surgery, University of Washington, 1959 NE Pacific St, Box 356515, Seattle, WA, 98195, USA; Center for Clinical and Translational Research, Seattle Children's Hospita, USAl.
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20
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Phuaksaman C, Niyomkarn W, Somboon P, Boonjindasup W, Hantragool S, Sritippayawan S. Long-term Outcomes of Pediatric Tracheostomy Home Care in a Limited Resource Setting of Professional Home Nurse. HOME HEALTH CARE MANAGEMENT AND PRACTICE 2022. [DOI: 10.1177/10848223221082661] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Long-term outcomes of pediatric patients with a tracheostomy in developing countries where professional home nurse is not accessible has rarely been reported. We, therefore, investigated the prevalence and associating factors of long-term outcomes in these children. Retrospective chart review was conducted in 85 tracheostomized children who were discharged to home during January 2012 to December 2020. Tracheostomy home care was provided by caregivers who completed the tracheostomy home care program. Prevalence of unplanned readmission with acute respiratory problems within 30 days after the first hospital discharge was 17.6%. Lower respiratory tract infection (LRTI) after hospital discharge was found in 72.9% (median frequency of 1.0 episode/case/year). Among 80 children who had surveillance airway endoscopy, 46.3% demonstrated late tracheostomy-related airway complications. Independent factor associated with late tracheostomy-related airway complications was a follow-up period longer than 1 year. Decannulation success was found in 21.2%. Most of them had tracheostomy for their upper airway anomalies. The mortality rate was 7%. Most of them died from their underlying diseases. In conclusion, pediatric tracheostomy home care undertaken by caregivers is feasible in developing countries where home nurse is not available. The prevalence of unplanned readmission with acute respiratory problems within 30 days after hospital discharge and late tracheostomy-related airway complications were comparable with those reported in developed countries. However, we still had a high prevalence of post-tracheostomy LRTI which was a challenging problem that needed to be investigated and resolved.
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