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Ha TAN, Jain S, Schuman A, Ongkasuwan J. Pediatric Tracheotomy Stomal Maturation and Tracheocutaneous Fistulas. Laryngoscope 2024; 134:2941-2944. [PMID: 38265121 DOI: 10.1002/lary.31271] [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: 08/03/2023] [Revised: 12/02/2023] [Accepted: 12/22/2023] [Indexed: 01/25/2024]
Abstract
OBJECTIVE The purpose of this study is to determine whether tracheostomy stomal maturation affects the risk of tracheocutaneous fistula (TCF) in children. METHODS A retrospective chart review was conducted for all children who both underwent a tracheostomy and were decannulated between 2012 and 2021 at a tertiary children's hospital. Charts were analyzed for demographics, surgical technique, and development of a TCF. TCF was defined as a persistent fistula following 3 months after decannulation. RESULTS 179 children met inclusion criteria. The median (interquartile range) age at tracheostomy was 1.5 (82.4) months, average (standard deviation [SD]) duration of tracheotomy was 20.0 (20.6) months, and length of follow-up after decannulation (range; SD) was 39.3 (4.4-110.0; 26.7) months. 107 patients (60.0%) underwent stomal maturation and 98 patients developed a TCF (54.7%). Younger age at tracheostomy placement was significantly associated with increased risk of TCF, mean (SD) age 28.4 (51.4) version 80.1 (77.5) months (p < 0.001). Increased duration of tracheostomy was significantly associated with increased risk of TCF, 27.5 (18.4) version 11.0 (18.2) months (p < 0.001). Stomal maturation was not significantly associated with the risk of TCF, including on multivariable analysis adjusting for age at tracheostomy and duration of tracheostomy (p = 0.089). CONCLUSION Tracheostomy stomal maturation did not affect the risk of TCF in children, even after adjusting for age and duration of tracheostomy. LEVEL OF EVIDENCE 4 Laryngoscope, 134:2941-2944, 2024.
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Affiliation(s)
- Tu-Anh N Ha
- Bobby R. Alford Department of Otolaryngology Head and Neck Surgery, Baylor College of Medicine, Houston, Texas, U.S.A
| | - Samagra Jain
- Bobby R. Alford Department of Otolaryngology Head and Neck Surgery, Baylor College of Medicine, Houston, Texas, U.S.A
| | - Ari Schuman
- Bobby R. Alford Department of Otolaryngology Head and Neck Surgery, Baylor College of Medicine, Houston, Texas, U.S.A
| | - Julina Ongkasuwan
- Bobby R. Alford Department of Otolaryngology Head and Neck Surgery, Baylor College of Medicine, Houston, Texas, U.S.A
- Department of Otolaryngology, Texas Children's Hospital, Houston, Texas, U.S.A
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Miu K, Magill J, Wyatt M, Hewitt R, Butler C, Cooke J. Revisiting the Great Ormond Street Hospital protocol for ward decannulation of children with tracheostomy. Int J Pediatr Otorhinolaryngol 2024; 176:111787. [PMID: 37988917 DOI: 10.1016/j.ijporl.2023.111787] [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: 09/27/2023] [Revised: 11/02/2023] [Accepted: 11/12/2023] [Indexed: 11/23/2023]
Abstract
INTRODUCTION Tracheostomy decannulation is an important and final step in managing patients once the underlying issue requiring a tracheostomy resolves. However, no consensus exists on the optimal method to decannulate a paediatric patient. We revisit the Great Ormond Street Hospital (GOSH) tracheostomy decannulation protocol, a 5-day process involving downsizing the tracheostomy tube, capping, and observation, to evaluate its effectiveness and assess if changes to the protocol are required. METHOD This is a retrospective study, reviewing patient records between April 2018 and April 2023 from a single quaternary care centre. Data extracted include comorbidities, age at the time of decannulation, duration of tracheostomy, reason for tracheostomy insertion, whether a decannulation attempt was successful or not, and the timings of decannulation failure. RESULTS 66 patients that met the selection criteria underwent a decannulation trial between April 2018 and April 2023. 32 patients were male, and 34 patients were female. Age at attempted decannulations ranged from 1 year to 18 years, with an average age of 6.1 years. There were a total of 93 attempts at decannulation, with 51 (54.8%) successful attempts, 35 (56.5%) first decannulation attempt successes, and 42 (45.2%) unsuccessful attempts. 17 patients had 2 attempts at decannulation, and 4 patients had 3 or more attempts at decannulation. Of the unsuccessful attempts, patients mostly failed on capping of the tracheostomy tube with 33 failures (35.5%). CONCLUSION The GOSH protocol achieved similar success rates to comparable protocols. The protocol's multi-step approach provides thorough evaluation and support for patients during the decannulation process, and its success on a complex patient cohort supports its continued use.
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Affiliation(s)
- Kelvin Miu
- Department of Otorhinolaryngology, Great Ormond Street Hospital, Great Ormond Street, London, WC1N 3JH, United Kingdom.
| | - Jennifer Magill
- Department of Otorhinolaryngology, The Royal London Hospital, Whitechapel Road, London, E1 1FR, United Kingdom.
| | - Michelle Wyatt
- Department of Otorhinolaryngology, Great Ormond Street Hospital, Great Ormond Street, London, WC1N 3JH, United Kingdom.
| | - Richard Hewitt
- Department of Otorhinolaryngology, Great Ormond Street Hospital, Great Ormond Street, London, WC1N 3JH, United Kingdom.
| | - Colin Butler
- Department of Otorhinolaryngology, Great Ormond Street Hospital, Great Ormond Street, London, WC1N 3JH, United Kingdom.
| | - Joanne Cooke
- Department of Otorhinolaryngology, Great Ormond Street Hospital, Great Ormond Street, London, WC1N 3JH, United Kingdom.
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Çelikal Ö, Günaydın RÖ, Akyol MU. Evaluation of the effects of three different tracheotomy techniques on tracheal complications and decannulation. Auris Nasus Larynx 2021; 49:670-675. [DOI: 10.1016/j.anl.2021.11.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2021] [Revised: 10/16/2021] [Accepted: 11/30/2021] [Indexed: 10/19/2022]
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Update on Pediatric Tracheostomy: Indications, Technique, Education, and Decannulation. CURRENT OTORHINOLARYNGOLOGY REPORTS 2021; 9:188-199. [PMID: 33875932 PMCID: PMC8047564 DOI: 10.1007/s40136-021-00340-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/03/2021] [Indexed: 12/23/2022]
Abstract
Purpose of Review Tracheostomy in a child demands critical pre-operative evaluation, deliberate family education, competent surgical technique, and multidisciplinary post-operative care. The goals of pediatric tracheostomy are to establish a safe airway, optimize ventilation, and expedite discharge. Herein we provide an update regarding timing, surgical technique, complications, and decannulation, focusing on a longitudinal approach to pediatric tracheostomy care. Recent Findings Pediatric tracheostomy is performed in approximately 0.2% of inpatient stays among tertiary pediatric hospitals. Mortality in children with tracheostomies ranges from 10–20% due to significant comorbidities in this population. Tracheostomy-specific mortality and complications are now rare. Recent global initiatives have aimed to optimize decision-making, lower surgical costs, reduce the length of intensive care, and eliminate perioperative wound complications. The safest road to tracheostomy decannulation in children remains to be both patient and provider dependent. Summary Recent literature provides guidance on safe, uncomplicated, and long-term tracheostomy care in children. Further research is needed to help standardize decannulation protocols.
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Chorney SR, Stow J, Javia LR, Zur KB, Jacobs IN, Sobol SE. Tracheocutaneous Fistula After Pediatric Open Airway Reconstruction. Ann Otol Rhinol Laryngol 2021; 130:948-953. [PMID: 33412912 DOI: 10.1177/0003489420987426] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVES Tracheocutaneous fistula (TCF) is a common occurrence after pediatric tracheostomy decannulation. However, the persistence of TCF after staged reconstruction of the pediatric airway is not well-described. The primary objective was to determine the rate of persistent TCF after successful decannulation in children with staged open airway reconstruction. METHODS A case series with chart review of children who underwent decannulation after double-stage laryngotracheal reconstruction between 2017 and 2019. RESULTS A total of 26 children were included. The most common open airway procedure was anterior and posterior costal cartilage grafting (84.6%, 22/26). Median age at decannulation was 3.4 years (IQR: 2.8-4.3) and occurred 7.0 months (IQR: 4.3-10.4) after airway reconstruction. TCF persisted in 84.6% (22/26) of children while 15.4% (4/26) of stomas closed spontaneously. All closures were identified by the one-month follow-up visit. There was no difference in age at tracheostomy (P = .86), age at decannulation (P = .97), duration of tracheostomy (P = .43), or gestational age (P = .23) between stomas that persisted or closed. Median diameter of stent used at reconstruction was larger in TCFs that persisted (7.0 mm vs 6.5 mm, P = .03). Tracheostomy tube diameter (P = .02) and stent size (P < .01) correlated with persistence of TCF on multivariable logistic regression analysis. There were 16 surgical closure procedures, which occurred at a median of 14.4 months (IQR: 11.4-15.4) after decannulation. Techniques included 56.3% (9/16) by primary closure, 18.8% (3/16) by secondary intention and 25% (4/16) by cartilage tracheoplasty. The overall success of closure was 93.8% (15/16) at latest follow-up. CONCLUSIONS Persistent TCF occurs in 85% of children who are successfully decannulated after staged open airway reconstruction. Spontaneous closure could be identified by 1 month after decannulation and was more likely when smaller stents and tracheostomy tubes were utilized. Surgeons should counsel families on the frequency of TCF and the potential for additional procedures needed for closure.
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Affiliation(s)
- Stephen R Chorney
- Department of Otolaryngology - Head & Neck Surgery, University of Texas Southwestern Medical Center, Dallas, TX, USA.,Department of Pediatric Otolaryngology, Children's Medical Center Dallas, Dallas, TX, USA
| | - Joanne Stow
- Division of Otolaryngology, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Luv R Javia
- Division of Otolaryngology, Children's Hospital of Philadelphia, Philadelphia, PA, USA.,Department of Otorhinolaryngology - Head and Neck Surgery, Perelman School of Medicine at University of Pennsylvania, Philadelphia, PA, USA
| | - Karen B Zur
- Division of Otolaryngology, Children's Hospital of Philadelphia, Philadelphia, PA, USA.,Department of Otorhinolaryngology - Head and Neck Surgery, Perelman School of Medicine at University of Pennsylvania, Philadelphia, PA, USA
| | - Ian N Jacobs
- Division of Otolaryngology, Children's Hospital of Philadelphia, Philadelphia, PA, USA.,Department of Otorhinolaryngology - Head and Neck Surgery, Perelman School of Medicine at University of Pennsylvania, Philadelphia, PA, USA
| | - Steven E Sobol
- Division of Otolaryngology, Children's Hospital of Philadelphia, Philadelphia, PA, USA.,Department of Otorhinolaryngology - Head and Neck Surgery, Perelman School of Medicine at University of Pennsylvania, Philadelphia, PA, USA
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Lubianca Neto JF, Castagno OC, Schuster AK. Complications of tracheostomy in children: a systematic review. Braz J Otorhinolaryngol 2020; 88:882-890. [PMID: 33472759 PMCID: PMC9615521 DOI: 10.1016/j.bjorl.2020.12.006] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2020] [Revised: 12/03/2020] [Accepted: 12/06/2020] [Indexed: 11/30/2022] Open
Abstract
Introduction Tracheostomy is a procedure that can be associated with several well-described complications in the literature, which can be divided into transoperative, early postoperative and late postoperative. When performed in children, these risks are more common than in adults. Objective To perform a systematic review of complications, including deaths, in tracheostomized pediatric patients. Methods A search was carried out for articles in the Latin American and Caribbean Health Sciences Literature and PubMed databases. Cohort studies and series reports were selected, in addition to systematic reviews, published between January 1978 and June 2020, with patients up to 18 years old, and written in English, Spanish or Portuguese. Results 1560 articles were found, of which 49 were included in this review. The average complication rate was 40%, which showed an association with age, birth weight, prematurity, comorbidities, and emergency procedures. The most common complications were cutaneous lesions and granulomas. Mortality related to the procedure reached up to 6% in children and was mainly related to cannula obstruction or accidental decannulation. Conclusion Pediatric tracheostomy is associated with several complications. The tracheostomy-related mortality rate is low, but the overall mortality of tracheostomized patients is not negligible.
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Affiliation(s)
- José Faibes Lubianca Neto
- Universidade Federal de Ciências da Saúde de Porto Alegre (UFCSPA), Disciplina de Otorrinolaringologia (ORL) e Programa de Pós-Graduação em Pediatria, Porto Alegre, RS, Brazil; Hospital da Criança Santo Antônio, Serviço de ORL Pediátrica, Programa Programa de Fellowship em ORL Pediátrica Otorrinolaringologia Pediátrica, Porto Alegre, RS, Brazil; Santa Casa de Misericórdia de Porto Alegre (UFCSPA), Serviço de ORL, Programa de Residência Médica em Otorrinolaringologia, Porto Alegre, RS, Brazil.
| | - Octavia Carvalhal Castagno
- Hospital da Criança Santo Antônio, Serviço de ORL Pediátrica, Programa Programa de Fellowship em ORL Pediátrica Otorrinolaringologia Pediátrica, Porto Alegre, RS, Brazil
| | - Artur Koerig Schuster
- Santa Casa de Misericórdia de Porto Alegre (UFCSPA), Serviço de ORL, Programa de Residência Médica em Otorrinolaringologia, Porto Alegre, RS, Brazil
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Chorney SR, Patel RC, Boyd AE, Stow J, Schmitt MM, Lipman D, Dailey JF, Nhan C, Giordano T, Sobol SE. Timing the First Pediatric Tracheostomy Tube Change: A Randomized Controlled Trial. Otolaryngol Head Neck Surg 2020; 164:869-876. [PMID: 32928049 DOI: 10.1177/0194599820954137] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE The first pediatric tracheostomy tube change often occurs within 7 days after placement; however, the optimal timing is not known. The primary objective was to determine the rate of adverse events of an early tube change. Secondary objectives compared rates of significant peristomal wounds, sedation requirements, and expedited intensive care discharges. STUDY DESIGN Prospective randomized controlled trial. SETTING Tertiary children's hospital between October 2018 and April 2020. METHODS A randomized controlled trial enrolled children under 24 months to early (day 4) or late (day 7) first tracheostomy tube changes. RESULTS Sixteen children were enrolled with 10 randomized to an early change. Median age was 5.9 months (interquartile range, 5.4-8.3), and 86.7% required tracheostomy for respiratory failure. All tracheostomy tube changes were performed without adverse events. There were no accidental decannulations. Significant wounds developed in 10% of children with early tracheostomy tube changes and 83.3% of children with late tracheostomy tube changes (odds ratio [OR], 45.0; 95% CI, 2.3-885.6; P = .01). This significant reduction in wound complications justified concluding trial enrollment. Hours of dexmedetomidine sedation (P = .11) and boluses of midazolam during the first 7 days (P = .08) were no different between groups. After the first change, 90% of the early group were discharged from intensive care within 5 weeks compared to 33.3% of patients in the late group (OR, 18.0; 95% CI, 1.2-260.9; P = .03). CONCLUSION The first tracheostomy tube change in children can occur without adverse events on day 4, resulting in fewer significant peristomal wounds and earlier intensive care discharge.
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Affiliation(s)
- Stephen R Chorney
- Division of Otolaryngology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA.,Department of Otorhinolaryngology-Head and Neck Surgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Rosemary C Patel
- Division of Otolaryngology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Allison E Boyd
- Division of Otolaryngology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Joanne Stow
- Division of Otolaryngology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Mary M Schmitt
- Division of Otolaryngology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Deborah Lipman
- Division of Otolaryngology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Julia F Dailey
- Division of Otolaryngology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Carol Nhan
- Division of Otolaryngology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA.,Department of Otorhinolaryngology-Head and Neck Surgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Terri Giordano
- Division of Otolaryngology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Steven E Sobol
- Division of Otolaryngology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA.,Department of Otorhinolaryngology-Head and Neck Surgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
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Wisniewski BL, Jensen EL, Prager JD, Wine TM, Baker CD. Pediatric tracheocutaneous fistula closure following tracheostomy decannulation. Int J Pediatr Otorhinolaryngol 2019; 125:122-127. [PMID: 31299421 DOI: 10.1016/j.ijporl.2019.07.001] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/21/2019] [Revised: 07/01/2019] [Accepted: 07/02/2019] [Indexed: 11/19/2022]
Abstract
OBJECTIVE To determine the frequency and risk factors that lead to the development of persistent TCF (tracheocutaneous fistula) formation in children following tracheostomy decannulation at our institution. METHODS A retrospective chart review of all pediatric patients at Children's Hospital Colorado who underwent tracheostomy decannulation and were being followed between January 1, 2007 and December 31, 2013. TCF was defined as a persistent fistula six months following decannulation. We determined patient demographics, age at tracheotomy, primary indication for tracheotomy, tracheostomy-tube size, medical comorbidities, age at decannulation, date of TCF closure, and method of TCF closure. RESULTS One hundred twenty-nine patients ranging from 51 days to 19 years of age underwent tracheostomy decannulation. 63 (49%) patients underwent surgical closure of TCF. Compared to those with spontaneous closure by multivariable analysis, those with surgical closure were younger at tracheostomy placement (p = 0.0002), had a tracheostomy for a longer duration (p = 0.0025), and were diagnosed with tracheobronchomalacia (p = 0.0051). The likelihood of spontaneous closure decreased over time. Tracheostomy tube internal diameter correlated with age (R = 0.64, p < 0.0001). CONCLUSIONS Approximately 50% of pediatric tracheostomy stoma sites will close spontaneously. Development of a persistent TCF was associated with younger age at placement, longer duration of tracheostomy, and the presence of tracheobronchomalacia. These observations may help clinicians anticipate outcomes following tracheostomy decannulation in children.
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Affiliation(s)
- Benjamin L Wisniewski
- Department of Pediatrics, Section of Pulmonary Medicine, The Ohio State University College of Medicine, Nationwide Children's Hospital, Columbus, Ohio, USA
| | - Emily L Jensen
- Department of Otolaryngology, University of Colorado School of Medicine and Children's Hospital Colorado, Aurora, CO, USA
| | - Jeremy D Prager
- Department of Otolaryngology, University of Colorado School of Medicine and Children's Hospital Colorado, Aurora, CO, USA
| | - Todd M Wine
- Department of Otolaryngology, University of Colorado School of Medicine and Children's Hospital Colorado, Aurora, CO, USA
| | - Christopher D Baker
- Department of Pediatrics, Section of Pulmonary Medicine, University of Colorado School of Medicine, Aurora, CO, USA.
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Woods R, Geyer L, Mehanna R, Russell J. Pediatric tracheostomy first tube change: When is it safe? Int J Pediatr Otorhinolaryngol 2019; 120:78-81. [PMID: 30772616 DOI: 10.1016/j.ijporl.2019.02.017] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2018] [Revised: 02/03/2019] [Accepted: 02/05/2019] [Indexed: 11/30/2022]
Abstract
OBJECTIVES The first tracheostomy tube change is typically performed on days 5-7 post-operatively, however recent international consensus guidelines suggested that, with maturation sutures, days 3-5 is appropriate. We evaluate whether a first tube change on day 2 post-operatively is safe and effective. METHODS We carried out a retrospective review of all patients undergoing tracheostomy between 2009 and 2018. Exclusion criteria were patients on whom the senior authors did not operate, operations done elsewhere, cases where maturation sutures were not used or a patient died prior to first tube change. We noted patient details, indication for tracheostomy, the need for long-term ventilation, timing of the first tube change, decannulation and need for surgical closure of persistent tracheocutaneous fistula. RESULTS 93 patients were identified, of which 83 were included. The age range was 0-16 years, with the youngest day one of life and an overall mean age of 1.91 years. 59% of patients required long-term ventilation due to various co-morbidities. 26 patients (31%) underwent a first tube change on day 2 post-operatively. All these were uneventful and were irrespective of the patient's need for ventilation. Of the 42 patients who have subsequently been decannulated, 33 (79%) were noted to have a persistent tracheocutaneous fistula requiring surgical closure, four of whom needed revision closure. CONCLUSIONS This study shows that a first tube change on day 2 post-operatively is safe, facilitating earlier discharge from intensive care, allowing shorter length of sedation, earlier start to parent/carer training and wound assessment.
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Affiliation(s)
- R Woods
- Department of Pediatric Otorhinolaryngology, Our Lady's Children's Hospital Crumlin, Dublin, Ireland.
| | - L Geyer
- Department of Pediatric Otorhinolaryngology, Our Lady's Children's Hospital Crumlin, Dublin, Ireland
| | - R Mehanna
- Department of Pediatric Otorhinolaryngology, Our Lady's Children's Hospital Crumlin, Dublin, Ireland
| | - J Russell
- Department of Pediatric Otorhinolaryngology, Our Lady's Children's Hospital Crumlin, Dublin, Ireland
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Seligman KL, Liming BJ, Smith RJH. Pediatric Tracheostomy Decannulation: 11-Year Experience. Otolaryngol Head Neck Surg 2019; 161:499-506. [PMID: 30987524 DOI: 10.1177/0194599819842164] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVE To determine the successful decannulation rate with a published pediatric tracheostomy decannulation protocol. STUDY DESIGN Case series with chart review. SETTING A single tertiary care institution. SUBJECTS AND METHODS A chart review was performed for patients aged ≤5 years who underwent tracheostomy. Extracted data included demographic data, indication for tracheostomy, age at tracheostomy and decannulation, comorbidities, and surgical complications. Records were searched for documentation of early decannulation failure (within 1 month of decannulation) or late failure (within 1 year). RESULTS Forty patients with a tracheostomy aged ≤5 years underwent attempted decannulation during the 11-year study period. Seventeen patients were excluded from the study for documentation of nonprotocol decannulation. The final study population of 23 patients underwent a total of 27 decannulations, 26 of which were performed by protocol. Of the 26 protocol decannulations, 22 were successful, for a failure rate of 15%. CONCLUSION Twenty-six protocol decannulations were attempted among 23 patients, 4 of which were unsuccessful for an overall failure rate of 15%. This result is consistent with rates reported in other published decannulation protocols. We believe that our protocol minimizes resource utilization in its use of pulse oximetry over polysomnography, while maximizing patient safety and success through the use of capping trials for very young and very small pediatric patients.
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Affiliation(s)
- Kristen L Seligman
- 1 Department of Otolaryngology-Head and Neck Surgery, University of Iowa, Iowa City, Iowa, USA
| | - Bryan J Liming
- 2 Department of Otolaryngology-Head and Neck Surgery, Tripler Army Medical Center, Honolulu, Hawaii, USA
| | - Richard J H Smith
- 1 Department of Otolaryngology-Head and Neck Surgery, University of Iowa, Iowa City, Iowa, USA
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11
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Ha TA, Goyal M, Ongkasuwan J. Duration of tracheostomy dependence and development of tracheocutaneous fistula in children. Laryngoscope 2017; 127:2709-2712. [PMID: 28802009 DOI: 10.1002/lary.26718] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2017] [Revised: 04/14/2017] [Accepted: 05/08/2017] [Indexed: 11/06/2022]
Abstract
OBJECTIVE To determine whether the risk of developing a tracheocutaneous fistula (TCF) increases with longer tracheostomy dependence times in children. STUDY DESIGN Retrospective review of medical records. METHOD A retrospective chart review was conducted for all children who both underwent tracheotomy and were decannulated between 2002 and 2011 at a tertiary children's hospital. Charts were analyzed for duration of tracheostomy and evidence of TCF up to 12 months. Data for these criteria was available on 164 out of 182 patients. RESULTS A significant difference in the duration of tracheostomy dependence between children with and without resultant TCF was determined by the Wilcoxon signed rank test (P = 0.0003). The relative risk (RR) of a persistent TCF was significantly increased when the duration of tracheostomy dependence was greater than 24 months (RR = 2.5217, P < 0.005) when compared to those decannulated before 12 months. The mean tracheostomy dependence times for children with and without TCF were 33.1 and 23.4 months, respectively. Overall, 94 children (57.3%) developed a TCF. CONCLUSION To our knowledge, this study represents the largest collection of data for children who have been decannulated following tracheostomy placement. These data demonstrate that the risk of developing a TCF increases with longer tracheostomy dependence times in children. LEVEL OF EVIDENCE 4. Laryngoscope, 127:2709-2712, 2017.
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Affiliation(s)
- Tu-Anh Ha
- Bobby R. Alford Department of Otolaryngology-Head and Neck Surgery, Baylor College of Medicine, Houston, Texas, U.S.A
| | - Meha Goyal
- Bobby R. Alford Department of Otolaryngology-Head and Neck Surgery, Baylor College of Medicine, Houston, Texas, U.S.A
| | - Julina Ongkasuwan
- Bobby R. Alford Department of Otolaryngology-Head and Neck Surgery, Baylor College of Medicine, Houston, Texas, U.S.A.,Department of Otolaryngology, Texas Children's Hospital, Houston, Texas, U.S.A
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12
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Cohn JE, Weitzel M, Lentner M, Zwillenberg S, Lafferty D. In reference to Stomal maturation does not increase the rate of tracheocutaneous fistulas. Laryngoscope 2017; 127:E330. [PMID: 28127761 DOI: 10.1002/lary.26475] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2016] [Accepted: 11/04/2016] [Indexed: 11/11/2022]
Affiliation(s)
- Jason E Cohn
- The Department of Otolaryngology-Head and Neck Surgery, Philadelphia College of Osteopathic Medicine; and the Department of Pediatric Otolaryngology-Head and Neck Surgery, St. Christopher's Hospital for Children, Philadelphia, Pennsylvania, U.S.A
| | - Mark Weitzel
- The Department of Otolaryngology-Head and Neck Surgery, Philadelphia College of Osteopathic Medicine; and the Department of Pediatric Otolaryngology-Head and Neck Surgery, St. Christopher's Hospital for Children, Philadelphia, Pennsylvania, U.S.A
| | - Mark Lentner
- The Department of Otolaryngology-Head and Neck Surgery, Philadelphia College of Osteopathic Medicine; and the Department of Pediatric Otolaryngology-Head and Neck Surgery, St. Christopher's Hospital for Children, Philadelphia, Pennsylvania, U.S.A
| | - Seth Zwillenberg
- The Department of Pediatric Otolaryngology-Head and Neck Surgery, St. Christopher's Hospital for Children, Philadelphia, Pennsylvania, U.S.A
| | - David Lafferty
- The New York Institute of Technology College of Osteopathic Medicine, Old Westbury, New York, U.S.A
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