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Chen YC, Wang X, Teng YS, Yan S, Jia DS, Pan HG. Long-term Results of Endoscopic Percutaneous Suture Lateralization for Newborns with Bilateral Vocal Cord Paralysis. Laryngoscope 2024. [PMID: 39189311 DOI: 10.1002/lary.31720] [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: 03/14/2024] [Revised: 07/20/2024] [Accepted: 08/09/2024] [Indexed: 08/28/2024]
Abstract
PURPOSE Bilateral vocal fold paralysis (BVFP) is a critical condition in newborns, which may present with significant airway distress necessitating tracheostomy. The purpose of this study is to report the safety and effectiveness of endoscopic percutaneous suture lateralization (EPSL) for newborns with BVFP, and evaluated the long-term results and the stability of the lateralization. METHODS A review of patients undergoing EPSL for BVFP at our institutions was performed between October 2018 and June 2023. Preoperative and postoperative clinical information was collected. The functional outcomes of the surgery in terms of breathing, voice, and swallowing were evaluated and recorded. RESULTS Twenty seven patients were included, with a median age at diagnosis of 12 days (range, 1-33 days). The maximum follow-up is for 5 years. EPSL was successful in 77.8% of cases, effectively avoiding the need for tracheostomy. Dyspnea was relieved within a month after surgery, enabling patients to tolerate oral feeds within 2 months after surgery. Notably, some patients experienced a return of vocal fold function, particularly in successful EPSL cases, underlining the procedure's efficacy. Minor complications, including granulation tissue and wound infection, were observed but were manageable. Major complications were notably absent. The results are durable and stable at long-term follow-up. CONCLUSION EPSL for BVFP is a relatively simple, minimally invasive, non-destructive, safe, and effective procedure in newborns, which may avoid the need for a tracheostomy, preserves the laryngeal framework, and does not affect the natural recovery of vocal cords. LEVEL OF EVIDENCE Level 3: retrospective case series Laryngoscope, 2024.
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Affiliation(s)
- Yong-Chao Chen
- Department of Otorhinolaryngology, Shenzhen Children's Hospital, Shenzhen, China
| | - Xin Wang
- Department of Otorhinolaryngology, Shenzhen Children's Hospital, Shenzhen, China
| | - Yi-Shu Teng
- Department of Otorhinolaryngology, Shenzhen Children's Hospital, Shenzhen, China
| | - Shang Yan
- Department of Otorhinolaryngology, Shenzhen Children's Hospital, Shenzhen, China
| | - De-Sheng Jia
- Department of Otorhinolaryngology, Shenzhen Children's Hospital, Shenzhen, China
| | - Hong-Guang Pan
- Department of Otorhinolaryngology, Shenzhen Children's Hospital, Shenzhen, China
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Bushroe KM, Crisp KD, Politi MC, Brennan SK, Housten AJ. Evaluating caregiver-clinician communication for tracheostomy placement in the neonatal intensive care unit: a qualitative inquiry. J Perinatol 2024; 44:963-969. [PMID: 37833495 PMCID: PMC11014892 DOI: 10.1038/s41372-023-01793-3] [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] [Received: 04/27/2023] [Revised: 09/07/2023] [Accepted: 09/26/2023] [Indexed: 10/15/2023]
Abstract
OBJECTIVE Identify stakeholders' tracheostomy decision-making information priorities in the Neonatal Intensive Care Unit (NICU). STUDY DESIGN English-speaking caregivers and clinicians who participated in NICU tracheostomy discussions between January 2017 and December 2021 were eligible. They reviewed a pediatric tracheostomy communication guide prior to meeting. Interviews focused on tracheostomy decision-making experiences, communication preferences, and guide perceptions. Interviews were recorded, transcribed, and analyzed using iterative inductive/deductive coding to inform thematic analysis. RESULTS Ten caregivers and nine clinicians were interviewed. Caregivers were surprised by the severity of their child's diagnosis and the intensive home care required, but proceeded with tracheostomy because it was the only chance for survival. All recommended that tracheostomy information be introduced early and in phases. Inadequate communication limited caregivers' understanding of post-surgical care and discharge requirements. All felt a guide could standardize communication. CONCLUSIONS Caregivers seek detailed information regarding expectations after tracheostomy placement in the NICU and at home.
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Affiliation(s)
- Kylie M Bushroe
- Department of Pediatrics, Division of Newborn Medicine, St. Louis Children's Hospital and Washington University in St. Louis School of Medicine, St. Louis, MO, USA.
| | - Kelly D Crisp
- College of Health and Human Sciences, Northern Illinois University, DeKalb, IL, USA
- Department of Surgery, Division of Public Health Sciences, Washington University in St. Louis School of Medicine, St. Louis, MO, USA
| | - Mary C Politi
- Department of Surgery, Division of Public Health Sciences, Washington University in St. Louis School of Medicine, St. Louis, MO, USA
| | - Steven K Brennan
- Department of Pediatrics, Division of Allergy and Pulmonary Medicine, St. Louis Children's Hospital and Washington University in St. Louis School of Medicine, St. Louis, MO, USA
| | - Ashley J Housten
- Department of Surgery, Division of Public Health Sciences, Washington University in St. Louis School of Medicine, St. Louis, MO, USA
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Mecham JC, Eitan DN, DeHart A, Gerber ME, Scheffler P. Endoscopic posterior cricoid split with costal cartilage graft placement in patients under one year of age. Int J Pediatr Otorhinolaryngol 2024; 181:111985. [PMID: 38776721 DOI: 10.1016/j.ijporl.2024.111985] [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: 03/22/2024] [Revised: 05/01/2024] [Accepted: 05/17/2024] [Indexed: 05/25/2024]
Abstract
Endoscopic posterior cricoid split and costal rib graft placement (EPCSCG) is an important tool in enlarging the glottic and subglottic airway, both of which can be disproportionally affected in the small airways of neonates and early infants. We present a series of 8 patients under the age of one who successfully underwent EPCSCG, with 7/8 patients avoiding tracheostomy entirely. Of these patients, the indication for EPCSCG was isolated bilateral vocal fold immobility (6/8), bilateral vocal fold immobility with subglottic stenosis (1/8), and isolated subglottic stenosis (1/8). EPCSCG can be safely applied to select patients less than one year of age.
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Affiliation(s)
- Jeffrey C Mecham
- Department of Otolaryngology, Head and Neck Surgery, Mayo Clinic, 5777 E Mayo Blvd, Phoenix, AZ, 85054, USA.
| | - Dana N Eitan
- Creighton University School of Medicine, 350 West Thomas Road, Phoenix, AZ, 85013, USA.
| | - Austin DeHart
- Department of Otolaryngology, Head and Neck Surgery, Mayo Clinic, 5777 E Mayo Blvd, Phoenix, AZ, 85054, USA; Division of Otolaryngology, Phoenix Children's Hospital, 1920 E Cambridge, Rosenberg Bldg, Suite 201, Phoenix, AZ, 85006, USA.
| | - Mark E Gerber
- Department of Otolaryngology, Head and Neck Surgery, Mayo Clinic, 5777 E Mayo Blvd, Phoenix, AZ, 85054, USA; Division of Otolaryngology, Phoenix Children's Hospital, 1920 E Cambridge, Rosenberg Bldg, Suite 201, Phoenix, AZ, 85006, USA.
| | - Patrick Scheffler
- Department of Otolaryngology, Head and Neck Surgery, Mayo Clinic, 5777 E Mayo Blvd, Phoenix, AZ, 85054, USA; Division of Otolaryngology, Phoenix Children's Hospital, 1920 E Cambridge, Rosenberg Bldg, Suite 201, Phoenix, AZ, 85006, USA.
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Lloyd AM, Behzadpour HK, Rana MS, Espinel AG. Factors associated with tracheostomy decannulation in infants with bronchopulmonary dysplasia. Int J Pediatr Otorhinolaryngol 2023; 175:111754. [PMID: 37847941 DOI: 10.1016/j.ijporl.2023.111754] [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: 05/07/2023] [Revised: 09/05/2023] [Accepted: 10/10/2023] [Indexed: 10/19/2023]
Abstract
OBJECTIVE Premature infants represent a unique subset of patients who may require tracheostomy. Bronchopulmonary dysplasia (BPD) is among one of the most common sequelae of prematurity contributing to the need for prolonged ventilation requiring tracheostomy after other airway options have been exhausted. Our objective is to understand socioeconomic barriers to decannulation and identify factors that accelerate safe decannulation, focusing on patients with BPD. METHODS An existing internal database from a tertiary pediatric hospital of patients undergoing tracheostomy prior to one year old was reviewed. Data from January 1, 2005 through December 31, 2020 was used to compare patients who were successfully decannulated to those who were not. A further subset of infants with BPD were identified and analyzed. Of those decannulated, survival analysis was used to identify factors associated with decreased time to decannulation. RESULTS We identified 303 infants who underwent tracheostomy at less than one year old with 125 of those infants having a diagnosis of BPD. Of the 125 infants with BPD, 44 (35.2 %) were decannulated and 81 (64.8 %) were not. There was no significant difference in sex, race, ethnicity, insurance status, comorbidities, or presence of syndromes between those patients with BPD who were decannulated and those who were not. Those who were not decannulated had a significantly longer length of hospital stay, prolonged ventilator requirements after tracheostomy, and were more likely to be discharged home on the ventilator (p = 0.030; 0.020; 0.002, respectively). Of the 44 decannulated patients, mean and median time to decannulation were 37.9 and 27.8 months respectively (range 10.8-160.6 months). There was an inverse association with decannulation and both Black race (HR: 0.30) and neurological comorbidity (HR: 0.37) on multivariate analysis. Black race, presence of syndrome, and length of ventilator dependence were significantly associated with increased time to decannulation. Time to decannulation from time off the ventilator was not significantly influenced by sex, race, ethnicity, state of residence, or insurance status, but was significantly influenced by age (95 % CI: -6.9, -0.1; P = 0.044). While time from discharge to first follow up visit did not significantly impact time to decannulation, every additional follow up visit increased time to decannulation by 3.78 months when adjusting for confounding variables. CONCLUSION In infants with BPD under one year requiring tracheostomy, socioeconomic factors were not found to influence likelihood of decannulation, however Black race, presence of underlying syndrome, and increased length of ventilator dependence were associated with prolonged timing. Children with more frequent follow up visits similarly had an increased time to decannulation, illustrating a vital point in the process. Ventilator weaning protocols and standardized decannulation protocols in patients with BPD, along with caregiver education, can safely expedite and facilitate decannulation.
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Affiliation(s)
- Ashley M Lloyd
- Division of Otolaryngology, George Washington University Hospital, Washington, DC, USA.
| | - Hengameh K Behzadpour
- Division of Pediatric Otolaryngology, Children's National Hospital, Washington, DC, USA
| | - Md Sohel Rana
- Department of Surgery, Children's National Hospital, Washington, DC, USA
| | - Alexandra G Espinel
- Division of Pediatric Otolaryngology, Children's National Hospital, Washington, DC, USA
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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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Bushroe K, Crisp K, Politi M, Brennan S, Housten A. Evaluating Caregiver-Clinician Communication for Tracheostomy Placement in the Neonatal Intensive Care Unit: A Qualitative Inquiry. RESEARCH SQUARE 2023:rs.3.rs-2869532. [PMID: 37205392 PMCID: PMC10187374 DOI: 10.21203/rs.3.rs-2869532/v1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/21/2023]
Abstract
Objective Identify stakeholders' tracheostomy decision-making information priorities in the Neonatal Intensive Care Unit (NICU). Study Design English-speaking caregivers and clinicians who participated in NICU tracheostomy discussions between January 2017 and December 2021 were eligible. They reviewed a pediatric tracheostomy communication guide prior to meeting. Interviews focused on tracheostomy decision-making experiences, communication preferences, and guide perceptions. Interviews were recorded, transcribed, and analyzed using iterative inductive/deductive coding to inform thematic analysis. Results Ten caregivers and nine clinicians were interviewed. Caregivers were surprised by the severity of their child's diagnosis and the intensive home care required, but proceeded with tracheostomy because it was the only chance for survival. All recommended that tracheostomy information be introduced early and in phases. Inadequate communication limited caregivers' understanding of post-surgical care and discharge requirements. All felt a guide could standardize communication. Conclusions Caregivers seek detailed information regarding expectations after tracheostomy placement in the NICU and at home.
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Affiliation(s)
- Kylie Bushroe
- Department of Pediatrics, Division of Newborn Medicine, St. Louis Children’s Hospital and Washington University in St. Louis School of Medicine
| | - Kelly Crisp
- College of Health and Human Sciences, Northern Illinois University
| | - Mary Politi
- Department of Surgery, Division of Public Health Sciences, Washington University in St. Louis School of Medicine
| | - Steven Brennan
- Department of Pediatrics, Division of Allergy and Pulmonary Medicine, St. Louis Children’s Hospital and Washington University in St. Louis School of Medicine
| | - Ashley Housten
- Department of Surgery, Division of Public Health Sciences, Washington University in St. Louis School of Medicine
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Attar MA, Pace RA, Schumacher RE. Pulmonary Support of Infants with Tracheotomies in a Regional Neonatal Intensive Care Unit. Am J Perinatol 2023; 40:539-545. [PMID: 33975361 DOI: 10.1055/s-0041-1729888] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
OBJECTIVE We evaluate patient characteristics, hospital course, and outcome by type discharge pulmonary support; mechanical ventilation (MV) or with tracheotomy masks (TM). STUDY DESIGN We reviewed records of infants admitted to the neonatal intensive care unit (NICU) that underwent tracheotomy within their first year of life between 2006 and 2017. We evaluated patient characteristics, referral pattern, destination of discharge, and outcome by type of pulmonary support at discharge (MV vs. TM). RESULTS Of the 168 patients, 63 (38%) were inborn, 91 (54%) transferred to our NICU, and 5 (3%) were readmitted after being home. Median gestational age at birth was 34 weeks. Twenty-three (14%) infants were transferred to hospitals closer to their homes (13 with MV and 10 with TM), and 125 (74%) were discharged home (75 on MV and 50 on TM). Twenty patients (12%) died in the regional center (RC). Among those discharged home from our RC, infants on MV were of lower birth weight and younger gestational age, had tracheostomies later in life, had longer duration between tracheostomy to discharge to home, and had longer total duration of hospitalization at the RC. In addition, infants in the MV group were more frequently dependent on MV at time of placement of tracheostomies, less frequently had congenital airway anomalies and more frequently having possibly acquired airway anomalies and more frequently having major congenital anomalies, more frequently treated with diuretics, inhaled medications and medications for pulmonary hypertension, and more frequently had gastrostomies for feeding compared with the TM group. CONCLUSION Patients with tracheostomies in the NICU and discharged from RC on MV or TM vary by patient characteristic, timing of tracheostomy placement, timing of discharge from RC, type of upper airway anomalies, duration of stay in the hospital, and complexity of medical condition at discharge. KEY POINTS · Infants on home mechanical ventilation have long hospital stay and complex conditions at discharge.. · We describe factors associated with the type of pulmonary support for infants with tracheostomies.. · Treatment strategy may influence type of discharge pulmonary support in infants with tracheostomies..
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Affiliation(s)
- Mohammad A Attar
- Department of Pediatrics and Communicable Diseases, University of Michigan, Ann Arbor, Michigan
| | - Rachael A Pace
- Department of Critical Care Support Services, University of Michigan Health System, Ann Arbor, Michigan
| | - Robert E Schumacher
- Department of Pediatrics and Communicable Diseases, University of Michigan, Ann Arbor, Michigan
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Endoscopic percutaneous suture lateralization with syringe needles for neonatal bilateral vocal cord paralysis. Am J Otolaryngol 2022; 43:103380. [PMID: 35256206 DOI: 10.1016/j.amjoto.2022.103380] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2021] [Accepted: 01/30/2022] [Indexed: 11/21/2022]
Abstract
OBJECTIVE To explore the novel technique of percutaneous endoscopic suture lateralization for bilateral vocal cord paralysis (BVCP) in neonates from Shenzhen, China, and to evaluate the safety and efficacy of the operation. METHODS In this retrospective case series, we present four neonates with BVCP diagnosed within 3 days after birth from Shenzhen Children's Hospital. All had stridor, respiratory distress and hypoxemia requiring respiratory support at diagnosis. Endoscopic vocal fold lateralization was performed under general anesthesia using 3.0 mm endotracheal intubation through the improved technique of percutaneous needle-directed placement of a 4-0 Prolene suture, without the use of specialized equipment. A 4-0 Prolene wire was led out through two 10 ml syringe needles, the left vocal cord was fully moved and fixed under the skin with endoscopy monitoring. RESULTS Overall, 3/4 of the patients showed clinical improvement in stridor and dyspnea 2-3 weeks after the operation and avoided a tracheostomy, two of them could breathe and feed normally when they were discharged from hospital, and one patient had a weak ability to suck but could breathe normally. The last patient had to undergo a tracheotomy due to the poor improvement in respiratory distress. None of the babies experienced any complications from this surgery, but case four presented with a series of complications and other problems in postoperative care related to the tracheostomy. At the last follow-up (mean 8 months), complete function of the bilateral vocal cords was acquired in case two (6 months) and partial function of the vocal cords was acquired in case one (13 months), with the other cases still experiencing paralysis. CONCLUSION Endoscopic percutaneous suture lateralization may be a reversible, effective and minimally invasive primary treatment for neonatal BVCP. Most of neonates with BVCP undergoing this procedure avoided a tracheotomy.
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Wong CK, Harris L, Hicks M, Majaesic C, Schellenberg C, Kumaran K, Law BHY. Tracheostomies in term and preterm infants: A single-center Canadian retrospective cohort. Pediatr Pulmonol 2022; 57:991-999. [PMID: 35023318 DOI: 10.1002/ppul.25823] [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: 10/08/2021] [Revised: 12/14/2021] [Accepted: 01/08/2022] [Indexed: 11/06/2022]
Abstract
OBJECTIVE To examine patient characteristics, hospital course, and medical outcomes of neonatal tracheostomy at a single center. DESIGN Retrospective cohort study. SETTING Level III neonatal intensive care units (NICUs) in Edmonton, Canada. PATIENTS Infants admitted to NICU who underwent tracheostomy between January 2013 and December 2017 inclusive. MAIN OUTCOME MEASURES Hospital course, discharge, and 3-year post-tracheostomy outcomes were compared between preterm infants <29 weeks gestation and infants with congenital anomalies. RESULTS Forty-three infants were identified; seven were lost to follow-up and excluded. Of the 36 analyzed, 86% survived to discharge. At discharge, 13% were decannulated, 36% required no mechanical ventilation, and 52% required mechanical ventilation. Median hospitalization was 295 days. At 3 years post-tracheostomy, 97% were alive. Proportions of infants with tracheostomy in situ was 80%, 73%, and 60% at 1, 2, and 3 years post tracheostomy. Tracheostomy incidence was 2.7% for preterm infants <29 weeks gestational age with 55% for subglottic stenosis. All preterm infants received postnatal steroids. Preterm infants underwent tracheostomy at later chronological age (123 vs. 81 days, p < 0.001), but similar corrected gestational age (42 + 5 vs. 51 + 2 weeks, p = 0.095). Preterm infants had more intubation attempts (17 vs. 4, p < 0.001), total extubations (8 vs. 2, p < 0.001), and days on ventilation before tracheostomy (100 vs. 78, p < 0.001). CONCLUSIONS Infants who underwent tracheostomy in a Canadian public healthcare setting demonstrated decreasing tracheostomy dependence and high survival post tracheostomy, despite prolonged hospitalization. Preterm infants had more intubation and extubation events which may have contributed to airway injury.
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Affiliation(s)
- Chung-Kwun Wong
- Department of Pediatrics, University of Alberta, Edmonton, Canada.,Stollery Children's Hospital, Edmonton, Canada
| | - Lucy Harris
- Department of Pediatrics, University of Alberta, Edmonton, Canada
| | - Matthew Hicks
- Department of Pediatrics, University of Alberta, Edmonton, Canada.,Stollery Children's Hospital, Edmonton, Canada
| | - Carina Majaesic
- Department of Pediatrics, University of Alberta, Edmonton, Canada.,Stollery Children's Hospital, Edmonton, Canada
| | | | - Kumar Kumaran
- Department of Pediatrics, University of Alberta, Edmonton, Canada.,Stollery Children's Hospital, Edmonton, Canada
| | - Brenda H Y Law
- Department of Pediatrics, University of Alberta, Edmonton, Canada.,Stollery Children's Hospital, Edmonton, Canada
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Survival and decannulation across indications for infant tracheostomy: a twelve-year single-center cohort study. J Perinatol 2022; 42:72-78. [PMID: 34404923 DOI: 10.1038/s41372-021-01181-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2021] [Revised: 07/08/2021] [Accepted: 07/28/2021] [Indexed: 11/09/2022]
Abstract
OBJECTIVE Describe survival and decannulation following infant tracheostomy based on indication for tracheostomy placement. STUDY DESIGN Retrospective cohort study of infants who received tracheostomy at a single pediatric hospital over a twelve-year period. Primary and secondary indications were categorized into pulmonary, anatomic, cardiac, neurologic/musculoskeletal, and others. RESULTS A total of 378 infants underwent tracheostomy; 323 had sufficient data to be included in analyses of post-discharge outcomes. Overall mortality was 26.3%; post-operative and post-discharge mortality differed across primary indications (P = 0.03 and P = 0.005). Among survivors, 69.3% decannulated at a median age of 3.0 years (IQR 2.3, 4.5 years). Decannulation among survivors varied across primary indications (P = 0.002), ranging from 17% to 75%. In multivariable analysis, presence of a neurologic or musculoskeletal indication for tracheostomy was a significant negative predictor of future decannulation (aOR 0.10 [95% CI 0.02-0.44], P = 0.003). CONCLUSIONS Early childhood outcomes vary across indications for infant tracheostomy.
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Guirguis F, Chorney SR, Wang C, Lenes-Voit F, Shah GB, Mitchell RB, Johnson RF. Nationwide tracheostomy among neonatal admissions - A cross-sectional analysis. Int J Pediatr Otorhinolaryngol 2022; 152:110985. [PMID: 34799187 DOI: 10.1016/j.ijporl.2021.110985] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2021] [Revised: 11/05/2021] [Accepted: 11/13/2021] [Indexed: 12/13/2022]
Abstract
OBJECTIVE To describe characteristics and outcomes of infants admitted as neonates requiring tracheostomy placement. METHODS A cross-sectional analysis of the Kids' Inpatient Database (KID) between 2003 and 2016 included all children admitted within the first 28 days of life that had a tracheostomy placed prior to discharge. Patient characteristics and surgical outcomes were compared between term (≥37 weeks gestation) and preterm (<37 weeks gestation) infants. A subset analysis for Black or African American neonates was performed given disproportional preterm births. RESULTS An estimated 4268 (95% CI: 4123-4414) tracheostomies were performed in infants admitted as a neonate with preterm infants accounting for 47% (1998/4268). Among preterm children, 20% were Black or African American compared to 12% in the term group (P < .001). More preterm infants had bronchopulmonary dysplasia (46% vs. 14%, P < .001), cardiac defects (66% vs. 58%, P < .001) and developed pneumonia, newborn sepsis, or sepsis during admissions (P < .001). Laryngotracheal anomalies (25% vs. 18%, P < .001) and vocal cord paralysis (11% vs. 4.9%, P < .001) were more common in term infants. Median length of stay (LOS) (154 vs. 100 days, P < .001) and total charges ($1,395,106 vs. $917,478, P < .001) were greater among preterm infants. Mortality was no different between groups (13% vs. 15%, P = .07). Characteristics strongly associated with preterm status were newborn sepsis (OR: 2.31, 95% CI: 1.97-2.72, P < .001), bronchopulmonary dysplasia (OR: 2.17, 95% CI: 1.77-2.65, P < .001) and Black or African American race (OR: 1.78, 95% CI: 1.46-2.17, P < .001). The following factors increased among all neonates between the baseline year 2003 to the final study year 2016: complications of care (OR: 1.9, 95% CI: 1.5-2.5, P < .001); sepsis (OR: 4.1, 95% CI: 3.0-5.5, P < .001); congenital cardiac anomalies (OR: 5.8, 95% CI: 4.5-7.4, P < .001); and respiratory failure (OR: 1.9, 95% CI: 1.5-2.4, P < .001). Compared to other races, median LOS and total charges were greater among Black or African American infants. CONCLUSION Tracheostomies among preterm infants admitted as neonates reflect a growing and complex group with increased costs and hospitalization lengths. Black or African American children are disproportionately born preterm with higher costs and LOS compared to other racial cohorts. Future work will be necessary to design quality-improvement initiatives to improve outcomes for this vulnerable population.
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Affiliation(s)
- Fady Guirguis
- Department of Otolaryngology-Head and Neck Surgery, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Stephen R Chorney
- Department of Otolaryngology-Head and Neck Surgery, University of Texas Southwestern Medical Center, Dallas, TX, USA; Children's Health Airway Management Program (CHAMP), Children's Medical Center Dallas, Dallas, TX, USA
| | - Cynthia Wang
- Department of Otolaryngology-Head and Neck Surgery, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Felicity Lenes-Voit
- Department of Otolaryngology-Head and Neck Surgery, University of Texas Southwestern Medical Center, Dallas, TX, USA; Children's Health Airway Management Program (CHAMP), Children's Medical Center Dallas, Dallas, TX, USA
| | - Gopi B Shah
- Department of Otolaryngology-Head and Neck Surgery, University of Texas Southwestern Medical Center, Dallas, TX, USA; Children's Health Airway Management Program (CHAMP), Children's Medical Center Dallas, Dallas, TX, USA
| | - Ron B Mitchell
- Department of Otolaryngology-Head and Neck Surgery, University of Texas Southwestern Medical Center, Dallas, TX, USA; Children's Health Airway Management Program (CHAMP), Children's Medical Center Dallas, Dallas, TX, USA
| | - Romaine F Johnson
- Department of Otolaryngology-Head and Neck Surgery, University of Texas Southwestern Medical Center, Dallas, TX, USA; Children's Health Airway Management Program (CHAMP), Children's Medical Center Dallas, Dallas, TX, USA.
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12
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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.
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Affiliation(s)
- Christopher D Baker
- Department of Pediatrics, Section of Pulmonary and Sleep Medicine, University of Colorado School of Medicine, Aurora, Colorado, USA
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13
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Giambra BK, Mangeot C, Benscoter DT, Britto MT. A Description of Children Dependent on Long Term Ventilation via Tracheostomy and Their Hospital Resource Use. J Pediatr Nurs 2021; 61:96-101. [PMID: 33813374 DOI: 10.1016/j.pedn.2021.03.028] [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: 01/25/2021] [Revised: 03/24/2021] [Accepted: 03/27/2021] [Indexed: 10/21/2022]
Abstract
PURPOSE To describe the proportion of children with an index hospitalization in 2014 who had established long-term invasive ventilator dependence (LTVD), and determine regional variation in hospital length of stay, charges, and readmissions. DESIGN AND METHODS Multicenter, longitudinal, retrospective cohort study using a recently established algorithm to identify children with LTVD from the Pediatric Health Information System database with an index hospitalization at least once during 2014, excluding normal newborn care or chemotherapy, and the subset with established LTVD. Hospitals were grouped by geographic regions. Analysis included descriptive statistics and multi-variable mixed modeling for length of stay, charges, and readmissions. RESULTS Of the 615,883 unique children discharged from 45 children's hospitals in 2014, 2235 (0.4%) had established LTVD. Of these, 342 (15%) were hospitalized in the Northeast, 677 (30%) Midwest, 733 (32%) South and 481 (22%) West. Most had at least two complex chronic conditions (97%) and used a medical device for at least two body systems (71%). No statistically significant regional variation was found for length of stay, charges, or readmissions after adjustment for child demographics, admission type, disposition, primary diagnosis, ICU stay, and number of chronic conditions. CONCLUSIONS This study characterized the population of children with LTVD hospitalized in 2014. No regional variation was found for length of stay, charges, or readmissions. PRACTICE IMPLICATIONS Children with established LTVD make up a small subset of all children admitted to children's hospitals however, they require substantial, costly, multifaceted care as most have additional complex chronic conditions and require multiple medical devices.
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Affiliation(s)
- Barbara K Giambra
- Cincinnati Children's Hospital Medical Center, OH, United States of America; University of Cincinnati College of Nursing, OH, United States of America.
| | - Colleen Mangeot
- Cincinnati Children's Hospital Medical Center, OH, United States of America.
| | - Dan T Benscoter
- Cincinnati Children's Hospital Medical Center, OH, United States of America; Department of Pediatrics, University of Cincinnati College of Medicine, OH, United States of America.
| | - Maria T Britto
- Cincinnati Children's Hospital Medical Center, OH, United States of America; Department of Pediatrics, University of Cincinnati College of Medicine, OH, United States of America.
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14
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Walsh A, Furlong M, Mc Nally P, O'Reilly R, Javadpour S, Cox DW. Pediatric invasive long-term ventilation-A 10-year review. Pediatr Pulmonol 2021; 56:3410-3416. [PMID: 34357690 DOI: 10.1002/ppul.25618] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2021] [Revised: 07/20/2021] [Accepted: 08/04/2021] [Indexed: 11/06/2022]
Abstract
INTRODUCTION The number of children with complex physical and developmental pathologies, including chronic respiratory insufficiency, surviving and growing beyond early childhood continues to rise. No study has examined the clinical pathway of children on invasive long-term mechanical ventilation (LTMV) in an Irish setting. Our data over a 10-year period were reviewed to see if our demographics and outcomes are in line with global trends. METHODS Children's Health Ireland (CHI) at Crumlin, Dublin is Ireland's largest tertiary pediatric hospital. A retrospective review analyzed data from children in our center commenced on LTMV via a tracheostomy over 10 years (2009-2018). This data was subdivided into two epochs for statistical analysis of longitudinal trends. RESULTS Forty-six children were commenced on LTMV from 2009 to 2018. Many had complex medical diagnoses with associated comorbidities. Far less children, 30.4% (n = 14) commenced LTMV in the latter half of the 10-year period, they also fared better in all aspects of their treatment course. Focusing solely on children who have needed LTMV over this timeframe we have been able to isolate trends specific to this cohort. Less patients commenced LTMV on a year-on-year basis, and for those that require tracheostomy and LTMV, their journey to decannulation tends to be shorter. CONCLUSION Over the period reviewed, less patients over time necessitated LTMV, and those patients are being weaned and decannulated with ever more success. This has implications in terms of predicting numbers transitioning to adult services and allocation of hospital and community care resources.
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Affiliation(s)
- Aoibhinn Walsh
- Department of Respiratory Medicine, Children's Health Ireland at Crumlin, Dublin, Ireland
| | - Mairead Furlong
- Department of Respiratory Medicine, Children's Health Ireland at Crumlin, Dublin, Ireland
| | - Paul Mc Nally
- Department of Respiratory Medicine, Children's Health Ireland at Crumlin, Dublin, Ireland.,Department of Paediatrics, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Ruth O'Reilly
- Department of Respiratory Medicine, Children's Health Ireland at Crumlin, Dublin, Ireland
| | - Sheila Javadpour
- Department of Respiratory Medicine, Children's Health Ireland at Crumlin, Dublin, Ireland
| | - Desmond W Cox
- Department of Respiratory Medicine, Children's Health Ireland at Crumlin, Dublin, Ireland.,School of Medicine, University College Dublin, Dublin, Ireland
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15
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House M, Nathan A, Bhuiyan MAN, Ahlfeld SK. Morbidity and respiratory outcomes in infants requiring tracheostomy for severe bronchopulmonary dysplasia. Pediatr Pulmonol 2021; 56:2589-2596. [PMID: 34002957 DOI: 10.1002/ppul.25455] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2021] [Revised: 04/23/2021] [Accepted: 04/26/2021] [Indexed: 11/06/2022]
Abstract
OBJECTIVE The decision for tracheostomy for bronchopulmonary dysplasia (BPD) is highly variable and often dictated by local practice. We aimed to characterize morbidity, mortality, and respiratory outcomes in preterm infants undergoing tracheostomy for severe BPD. STUDY DESIGN We retrospectively reviewed a single-center 4-year cohort of all infants born <33 weeks gestational age (GA) that required tracheostomy due to severe BPD. Indications for tracheostomy apart from BPD were excluded. Demographic information, comorbidities, respiratory management, age at tracheostomy, post-discharge respiratory outcomes, and survival were examined up to at least 5 years of age. RESULTS At a mean corrected GA of 43.3 weeks, 49 preterm infants with severe BPD required tracheostomy. Forty-six infants (94%) had long-term follow-up. Compared to survivors, the 12 (26.1%) infants that died were significantly more likely to be small for gestational age (SGA) or require treatment for pulmonary hypertension. GA, birth weight, sex, antenatal corticosteroid exposure, need for patent ductus arteriosus ligation, and magnitude of respiratory support at tracheostomy placement were not associated with mortality. At the latest follow-up, 97% were liberated from mechanical ventilation and 79% decannulated. Morbidities of the upper airway were common, and 13/27 (47%) decannulated infants had required airway reconstruction. CONCLUSION Preterm infants undergoing tracheostomy experienced significant mortality, particularly those who were SGA or had pulmonary hypertension. However, by 5 years of age, most infants liberalized from mechanical ventilation and decannulated. Magnitude of respiratory support at time of tracheostomy was not associated with mortality and should not deter intervention. Nearly half of patients required airway reconstruction before decannulation.
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Affiliation(s)
- Melissa House
- Division of Neonatology and Pulmonary Biology, Perinatal Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA.,Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
| | - Amy Nathan
- Division of Neonatology and Pulmonary Biology, Perinatal Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA.,Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
| | | | - Shawn K Ahlfeld
- Division of Neonatology and Pulmonary Biology, Perinatal Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA.,Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
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16
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Meyer-Macaulay CB, Graham RJ, Williams D, Dorste A, Teele SA. "New Trach Mom Here…": A qualitative study of internet-based resources by caregivers of children with tracheostomy. Pediatr Pulmonol 2021; 56:2274-2283. [PMID: 33666349 DOI: 10.1002/ppul.25355] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2020] [Revised: 02/12/2021] [Accepted: 03/01/2021] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Decision-making around tracheostomy placement and chronic respiratory support in children is complicated. Families often seek support and advice from outside the medical care team, including from social media. We undertook this study to characterize the content and nature of online resources created and managed primarily by caregivers of children living with tracheostomy and chronic mechanical ventilation. DESIGN/SETTING We used a "grey literature" search methodology to identify internet resources created by caregivers of children with tracheostomy. We included only publicly available, nonindustry associated, English language, North American websites updated at least once in 2019. We then applied inductive content analysis to establish central themes, patterns and associations. MEASUREMENTS/MAIN RESULTS We identified six blogs/forums that met our search criteria. We identified four main themes: (1) Uncertainty, (2) Lived experience-wants, needs, and emotions, (3) Seeking context and meaning, and (4) Advice/information sharing/support. Two patterns of coping were identified on the basis of the relationships between codes. The "Acceptance pathway" is associated with a sense of self-actualization, mastery, satisfaction, return to normalcy, and ultimately acceptance. The "Resignation pathway" is associated with a sense of lack of control, frustration, burnout and stress, persistent lack of normalcy, and resignation to the tracheostomy as a negative but necessary outcome. CONCLUSION Caregivers often come to see themselves as experts in the care of children with tracheostomy, though many still express ambivalence about their knowledge and skills. Those early in the experience express a desire for community and can potentially benefit from online resources.
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Affiliation(s)
- Colin B Meyer-Macaulay
- Department of Cardiology, Boston Children's Hospital, Boston, Massachusetts, USA.,Harvard Medical School, Boston, Massachusetts, USA
| | - Robert J Graham
- Harvard Medical School, Boston, Massachusetts, USA.,Division of Critical Care Medicine, Department of Anesthesiology, Boston Children's Hospital, Critical Care Medicine and Pain Medicine, Boston, Massachusetts, USA
| | - David Williams
- Harvard Medical School, Boston, Massachusetts, USA.,Boston Children's Hospital, Institutional Centers for Clinical and Translational Studies, Boston, Massachusetts, USA
| | - Anna Dorste
- Boston Children's Hospital Medical Library, Boston, Massachusetts, USA
| | - Sarah A Teele
- Department of Cardiology, Boston Children's Hospital, Boston, Massachusetts, USA.,Harvard Medical School, Boston, Massachusetts, USA
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17
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Attar MA, Pace RA, Schumacher RE. Back Transfer of Infants with Tracheostomies: A Regional Center Experience. J Pediatr Intensive Care 2021; 12:118-124. [PMID: 37082470 PMCID: PMC10113006 DOI: 10.1055/s-0041-1730929] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2021] [Accepted: 04/12/2021] [Indexed: 10/21/2022] Open
Abstract
AbstractWe describe our center's experience with the back transfer of infants following tracheostomies. We conducted a retrospective cohort study of infants transferred to pediatric critical care units of our regional center with conditions originating in the neonatal period who underwent tracheostomy during the hospitalization within their first year of life between 2006 and 2017. Recovering patients are discharged home or transferred back to the referring hospitals. We evaluated patient characteristics, destination of discharge and type of pulmonary support at discharge, and mechanical ventilation (MV) or tracheotomy masks (TM). Of the 139 included patients, 72% were transferred to the neonatal intensive care unit, 21% to the pediatric cardiothoracic unit, and 7% to the pediatric intensive care unit. Their median gestational age was 35 weeks. They were admitted at a median 22 days of life and lived at a median distance of 56 miles from our center. Furthermore, 34 infants (24%) were back transferred closer to their homes (23 with MV and 11 with TM), and 84 (60%) were discharged home (53 on MV and 31 on TM). Twenty-one patients (15%) died in the hospital (before discharge or transfer). Back transferred patients on MV had a significantly shorter duration between tracheostomy and transfer compared with those discharged home from our center: MV (median = 22 vs. 103 days, p < 0.0001) and TM (median = 13 vs. 35 days, p < 0.0001). Back transfer of infants with tracheostomies closer to their homes was associated with a significantly shorter hospitalization and more efficient use of the subspecialized resources at the RC.
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Affiliation(s)
- Mohammad A. Attar
- Department of Pediatrics and Communicable Diseases, University of Michigan, Ann Arbor, Michigan, United States
| | - Rachael A. Pace
- Department of Critical Care Support Services, University of Michigan Health System, Ann Arbor, Michigan, United States
| | - Robert E. Schumacher
- Department of Pediatrics and Communicable Diseases, University of Michigan, Ann Arbor, Michigan, United States
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18
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Donda K, Agyemang CO, Adjetey NA, Agyekum A, Princewill N, Ayensu M, Bray L, Yagnik PJ, Bhatt P, Dapaah-Siakwan F. Tracheostomy trends in preterm infants with bronchopulmonary dysplasia in the United States: 2008-2017. Pediatr Pulmonol 2021; 56:1008-1017. [PMID: 33524218 DOI: 10.1002/ppul.25273] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/21/2020] [Revised: 01/03/2021] [Accepted: 01/11/2021] [Indexed: 12/11/2022]
Abstract
OBJECTIVE To determine the trends in tracheostomy placement and resource use in preterm infants less than or equal to 30 weeks gestational age (GA) with bronchopulmonary dysplasia (BPD) in the United States from 2008 to 2017. STUDY DESIGN This was a retrospective, serial cross-sectional study using data from the NIS. Inclusion criteria were: GA less than or equal to 30 weeks, hospitalization at less than or equal to 28 days of age, assignment of International Classification of Diseases, Ninth Revision, Clinical Modification (ICD9-CM) or ICD10-CM codes for BPD and tracheostomy. Trends in tracheostomy and resource utilization were assessed using Jonckheere-Terpstra test. p-value < .05 was considered significant. RESULTS Overall, 987 out of 68,953 (1.4%) hospitalizations with BPD had tracheostomy. Characteristics of the study population: 60.8% were male, 68.4% less than or equal to 26 weeks GA, 43.8% White, 60.5% with Medicaid or self-pay, 65.2% in the Midwest and South census regions of the United States, and 45.7% had gastrostomy tube placement. Tracheostomy placement (expressed as per 100,000 live births) decreased from 2.7 in 2008 to 1.9 in 2011. Thereafter, it increased from 1.9 in 2011 to 3.5 in 2017 (p < .001). GA less than or equal to 24 weeks was significantly associated with increased odds of tracheostomy placement. Median length of stay increased significantly from 170 to 231 days while median inflation adjusted hospital cost increased significantly from $323,091 in 2008-2009 to $687,141 between 2008-2009 and 2016-2017. CONCLUSION Although tracheostomy placement among preterm hospitalizations with BPD was rare, the frequency of its placement and its associated resource utilization significantly increased during the study period. Future studies should probe the reasons and factors behind these trends.
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Affiliation(s)
- Keyur Donda
- Department of Pediatrics, University of South Florida, Tampa, Florida, USA
| | | | - Naa A Adjetey
- Department of Pediatrics and Child Health, Upper West Regional Hospital, Wa, Ghana
| | - Afua Agyekum
- Department of Anesthesia, School of Medical Sciences, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | | | - Marian Ayensu
- The Trust Hospital, Accra, Greater Accra Region, Ghana
| | - Leonita Bray
- Department of Pediatrics, Woodhull Medical and Mental Health Center, Brooklyn, New York, USA
| | - Priyank J Yagnik
- Department of Pediatrics, University of Kansas School of Medicine, Wichita, Kansas, USA
| | - Parth Bhatt
- Department of Pediatrics, United Hospital Center, Bridgeport, West Virginia, USA
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19
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Annesi CA, Levin JC, Litt JS, Sheils CA, Hayden LP. Long-term respiratory and developmental outcomes in children with bronchopulmonary dysplasia and history of tracheostomy. J Perinatol 2021; 41:2645-2650. [PMID: 34290373 PMCID: PMC8294252 DOI: 10.1038/s41372-021-01144-0] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2021] [Revised: 06/20/2021] [Accepted: 06/30/2021] [Indexed: 11/12/2022]
Abstract
OBJECTIVE The long-term morbidity among children with severe bronchopulmonary dysplasia who require tracheostomy (tBPD) relative to those without tracheostomy (sBPD) is not well characterized. We compared childhood lung function and neurodevelopmental outcomes in tBPD and sBPD. STUDY DESIGN Retrospective case-control study of N = 49 tBPD and N = 280 sBPD subjects in Boston Children's Hospital Preterm Lung Patient Registry and medical record. We compared NICU course, childhood spirometry, and neurodevelopmental testing. RESULT tBPD subjects were more likely than sBPD to be Black, have pulmonary hypertension, and have subglottic stenosis. tBPD subjects had lower maximal childhood FEV1 % predicted (β = -0.14) and FEV1/FVC (β = -0.08); spirometry curves were more likely to suggest fixed extrathoracic obstruction. tBPD subjects had greater cognitive and motor delays <24 months, and greater cognitive delays >24 months. CONCLUSION Compared to subjects with sBPD who did not require tracheostomy, tBPD subjects suffer from increased long-term impairment in respiratory function and neurodevelopment.
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Affiliation(s)
- Chandler A. Annesi
- grid.189504.10000 0004 1936 7558Boston University School of Medicine, Boston, MA USA
| | - Jonathan C. Levin
- grid.2515.30000 0004 0378 8438Division of Pulmonary Medicine, Boston Children’s Hospital, Boston, MA USA ,grid.2515.30000 0004 0378 8438Division of Newborn Medicine, Boston Children’s Hospital, Boston, MA USA ,grid.38142.3c000000041936754XDepartment of Pediatrics, Harvard Medical School, Boston, MA USA
| | - Jonathan S. Litt
- grid.2515.30000 0004 0378 8438Division of Newborn Medicine, Boston Children’s Hospital, Boston, MA USA ,grid.38142.3c000000041936754XDepartment of Pediatrics, Harvard Medical School, Boston, MA USA
| | - Catherine A. Sheils
- grid.2515.30000 0004 0378 8438Division of Pulmonary Medicine, Boston Children’s Hospital, Boston, MA USA ,grid.38142.3c000000041936754XDepartment of Pediatrics, Harvard Medical School, Boston, MA USA
| | - Lystra P. Hayden
- grid.2515.30000 0004 0378 8438Division of Pulmonary Medicine, Boston Children’s Hospital, Boston, MA USA ,grid.38142.3c000000041936754XDepartment of Pediatrics, Harvard Medical School, Boston, MA USA ,grid.62560.370000 0004 0378 8294Channing Division of Network Medicine, Brigham and Women’s Hospital, Boston, MA USA
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20
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Rivera-Tocancipá D. Pediatric airway: What is new in approaches and treatments? COLOMBIAN JOURNAL OF ANESTHESIOLOGY 2020. [DOI: 10.5554/22562087.e945] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Perioperative morbidity and mortality are high among patients in the extremes of life undergoing anesthesia. Complications in children occur mainly as a result of airway management-related events such as difficult approach, laryngospasm, bronchospasm and severe hypoxemia, which may result in cardiac arrest, neurological deficit or death. Reports and new considerations that have changed clinical practice in pediatric airway management have emerged in recent years. This narrative literature review seeks to summarize and detail the findings on the primary cause of morbidity and mortality in pediatric anesthesia and to highlight those things that anesthetists need to be aware of, according to the scientific reports that have been changing practice in pediatric anesthesia.
This review focuses on the identification of “new” and specific practices that have emerged over the past 10 years and have helped reduce complications associated with pediatric airway management. At least 9 practices grouped into 4 groups are described: assessment, approach techniques, devices, and algorithms. The same devices used in adults are essentially all available for the management of the pediatric airway, and anesthesia-related morbidity and mortality can be reduced through improved quality of care in pediatrics.
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21
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Johnson RF, Brown A, Brooks R. The Family Impact of Having a Child with a Tracheostomy. Laryngoscope 2020; 131:911-915. [PMID: 32797676 DOI: 10.1002/lary.29003] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2020] [Revised: 05/19/2020] [Accepted: 07/13/2020] [Indexed: 12/21/2022]
Abstract
OBJECTIVES Measure the quality of life among families with children with tracheostomies. METHODS We performed a prospective cross-sectional analysis of families with children with tracheostomies utilizing the PedQL Family Impact Module-a validated quality of life assessment. We determined if scores were impacted by demographics using regression analysis. We also compared the tracheostomy sample's scores to a previously published cohort of children with severe cerebral palsy and birth defects that required home nursing or nursing home placement using the student's t-test. We determined the effect size of the difference between the two groups using the Cohen's d test. RESULTS Ninety-eight families are included in the study. The average (SD) age of tracheostomy placement was 1.6 (3.5) years. The population was 60% (59/98) male and 39% (38/98) Hispanic. The principal reason for tracheostomy was due to respiratory failure (76 out of 98; 78%). The mean (SD) total Family Impact score was 76 (19). The lowest domain score was daily activity problems, mean (SD) = 67 (30) followed by worry (mean = 69, SD = 24). The lowest question score was, "I worry about my child's future," mean (SD) = 52 (37). When compared to the comparison group of medically fragile children, the scores were statistically similar except for communication totals where tracheostomy patients reported superior scores (78.3 vs. 62.9, 95% CI, -26 to -4.8, P = .005, Cohen's d = -0.66). CONCLUSION The presence of a tracheostomy is associated with QOL scores like other medically fragile children. LEVEL OF EVIDENCE 4 Laryngoscope, 131:911-915, 2021.
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Affiliation(s)
- Romaine F Johnson
- Department of Otolaryngology - Head and Neck Surgery, UT Southwestern Medical Center, Dallas, Texas, U.S.A.,Children's Health Airway Management Program, Children's Medical Center Dallas, Dallas, Texas, U.S.A
| | - Ashley Brown
- Children's Health Airway Management Program, Children's Medical Center Dallas, Dallas, Texas, U.S.A
| | - Rebecca Brooks
- Children's Health Airway Management Program, Children's Medical Center Dallas, Dallas, Texas, U.S.A
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22
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Wood W, Wang CS, Mitchell RB, Shah GB, Johnson RF. A Longitudinal Analysis of Outcomes in Tracheostomy Placement Among Preterm Infants. Laryngoscope 2020; 131:417-422. [PMID: 32652622 DOI: 10.1002/lary.28864] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2020] [Revised: 04/23/2020] [Accepted: 05/23/2020] [Indexed: 12/20/2022]
Abstract
OBJECTIVES To study a case series of preterm and extremely preterm infants, comparing their decannulation and survival rates after tracheostomy. METHODS We performed a single-institution longitudinal study of preterm infants with a tracheostomy. Infants were categorized as premature (born > 28 weeks and < 37 weeks) and extremely premature (born ≤ 28 weeks). Decannulation and survival rates were determined using the Kaplan-Meier method. Neurocognitive quality of life (QOL) was reported as normal, mild/moderately, and severely impaired. Statistical significance was set at P < .05. RESULTS This study included 240 patients. Of those, 111 were premature and 129 were extremely preterm. The median age (interquartile range) at tracheostomy was 4.8 months (0.4). Premature infants were more likely than extremely preterm to have airway obstruction (54% vs. 32%, P < .001); whereas extremely preterm infants were more likely to have bronchopulmonary dysplasia (68% vs. 15%, P < .001) and to be ventilation-dependent (68% vs. 54%, P < .001). The 5-year decannulation rate for premature infants was 46% and for extremely preterm was 64%. The 5-year survival rate post-tracheostomy for preterm was 79% and for extremely preterm was 73%. The log-rank test of equality showed that decannulation and survival were similar (P > .05) for both groups, even after controlling for potentially confounding factors like race, age, gender, birth weight, and age at tracheostomy. For neurocognitive QOL, 47% of patients survived with severely impaired QOL after tracheostomy. Preterm had 56% with severely impaired QOL and extremely preterm had 40% with severely impaired QOL (P = .03). CONCLUSION This study demonstrated that the time to decannulation and the likelihood of survival did not vary among premature and extremely premature infants even when controlling for other confounding variables. LEVEL OF EVIDENCE 3b Laryngoscope, 131:417-422, 2021.
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Affiliation(s)
- William Wood
- Department of Otolaryngology - Head and Neck Surgery, UT Southwestern Medical Center, Dallas, Texas, U.S.A
| | - Cynthia S Wang
- Department of Otolaryngology - Head and Neck Surgery, UT Southwestern Medical Center, Dallas, Texas, U.S.A
| | - Ron B Mitchell
- Department of Otolaryngology - Head and Neck Surgery, UT Southwestern Medical Center, Dallas, Texas, U.S.A
| | - Gopi B Shah
- Department of Otolaryngology - Head and Neck Surgery, UT Southwestern Medical Center, Dallas, Texas, U.S.A
| | - Romaine F Johnson
- Department of Otolaryngology - Head and Neck Surgery, UT Southwestern Medical Center, Dallas, Texas, U.S.A
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23
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Abstract
Approximately half of all pediatric tracheostomies are performed in infants younger than 1 year. Most tracheostomies in patients in the NICU are performed in cases of chronic respiratory failure requiring prolonged mechanical ventilation or upper airway obstruction. With improvements in ventilation and management of long-term intubation, indications for tracheostomy and perioperative management in this population continue to evolve. Evidence-based protocols to guide routine postoperative care, prevent and manage tracheostomy emergencies including accidental decannulation and tube obstruction, and attempt elective decannulation are sparse. Clinician awareness of safe tracheostomy practices and larger, prospective studies in infants are needed to improve clinical care of this vulnerable population.
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Affiliation(s)
- Julia Chang
- Department of Otolaryngology, Head and Neck Surgery. Stanford University School of Medicine, Stanford, CA
| | - Douglas R Sidell
- Department of Otolaryngology, Head and Neck Surgery. Stanford University School of Medicine, Stanford, CA
- Stanford Pediatric Aerodigestive and Airway Reconstruction Center, Lucile Packard Children's Hospital, Stanford, CA
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24
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Bergeron Gallant K, Sauthier M, Kawaguchi A, Essouri S, Quintal MC, Emeriaud G, Jouvet P. Tracheostomy, respiratory support, and developmental outcomes in neonates with severe lung diseases: Retrospective study in one center. Arch Pediatr 2020; 27:270-274. [PMID: 32280047 DOI: 10.1016/j.arcped.2020.03.011] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2019] [Revised: 12/27/2019] [Accepted: 03/28/2020] [Indexed: 11/17/2022]
Abstract
OBJECTIVES Pediatric tracheostomy has evolved significantly in the past few decades and the optimal timing to perform it in children with respiratory assistance is still debated. The objective of this study was to describe the indications, timing, complications, and outcomes of infants on respiratory support who had a tracheostomy in a tertiary pediatric intensive care unit (PICU). METHODS All children younger than 18 months of corrected age requiring respiratory support for at least 1 week and who had a tracheostomy between January 2005 and December 2015 were included. Their demographic and clinical data and their outcomes at 24 months of corrected age were collected and analyzed after approval from the CHU Sainte-Justine ethics committee. RESULTS During the study period, 18 children (14 preterm infants, 4 polymalformative syndromes, and 2 diaphragmatic hernias) were included. The median corrected age at tracheostomy was 97 days (0-289 days) and 94.4% were elective. The indications for tracheostomy were ventilation for more than 7 days with (61.1%) or without (38.9%) orolaryngotracheal anomaly. The median number of consultants involved per patient was 16 consultants (10-23 consultants). The median hospital length of stay was 122 days (8-365 days) before tracheostomy and 235 days (22-891 days) after tracheostomy. The median invasive ventilation time was 68 days (8-168 days) before tracheostomy and 64 days (5-982 days) after tracheostomy. In terms of complications, there were nine cases of tracheitis and five cases of tracheal granulomas. At 24 months of corrected age, 17 of 18 children survived, one of/17 was still hospitalized, three of 17 were decannulated, three of 17 received respiratory support via their tracheostomy, 11 of 17 were fed with a gastrostomy, and all had neurodevelopmental delay. CONCLUSION Tracheostomy in infants requiring at least 1 week of ventilation is performed for complex cases and is favored for orolaryngotracheal anomalies. Clinicians should anticipate the need for developmental care in this population.
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Affiliation(s)
- K Bergeron Gallant
- Pediatric Intensive Care Unit, CHU Sainte-Justine, Montreal, Canada; University of Montreal, Montreal, Canada
| | - M Sauthier
- Pediatric Intensive Care Unit, CHU Sainte-Justine, Montreal, Canada; University of Montreal, Montreal, Canada
| | - A Kawaguchi
- Pediatric Intensive Care Unit, CHU Sainte-Justine, Montreal, Canada; University of Montreal, Montreal, Canada; University of Ottawa, Children's Hospital of Eastern Ontario, Ottawa, Canada
| | - S Essouri
- Pediatric Intensive Care Unit, CHU Sainte-Justine, Montreal, Canada; University of Montreal, Montreal, Canada
| | - M C Quintal
- Pediatric Intensive Care Unit, CHU Sainte-Justine, Montreal, Canada; University of Montreal, Montreal, Canada
| | - G Emeriaud
- Pediatric Intensive Care Unit, CHU Sainte-Justine, Montreal, Canada; University of Montreal, Montreal, Canada
| | - P Jouvet
- Pediatric Intensive Care Unit, CHU Sainte-Justine, Montreal, Canada; University of Montreal, Montreal, Canada.
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25
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Esianor BI, Jiang ZY, Diggs P, Yuksel S, Roy S, Huang Z. Pediatric tracheostomies in patients less than 2 years of age: Analysis of complications and long-term follow-up. Am J Otolaryngol 2020; 41:102368. [PMID: 31859007 DOI: 10.1016/j.amjoto.2019.102368] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2019] [Accepted: 12/03/2019] [Indexed: 11/19/2022]
Abstract
PURPOSE Identify variables that are predictive of morbidity and mortality in children under the age of two undergoing tracheostomy and to provide longitudinal data on this patient population. METHODS Patients were retrospectively identified using Current Procedural Terminology codes 31600, 31601, 31610 from 2009 to 2016. RESULTS Median age at time of tracheostomy was 0.43 years (interquartile range, 0.27-0.61). Patients were followed for a median of 1.39 years (range 0.03-4.25). Overall mortality rate in this cohort was 23.5% with the majority (81.3%) of deaths occurring >30 days following tracheostomy. The most frequently encountered major complication was cardiopulmonary arrest (10.29%) in the short-term follow up period (<30 days) and accidental decannulation (32.81%) during long-term follow up (>30 days). Peristomal skin breakdown was less likely to develop in patients who did not receive paralytics following tracheostomy. Most patients (54.4%) were discharged to home following initial admission and experienced a mean of 2.10 readmissions for any reason during the follow-up period. 64.4% of patients underwent surveillance direct laryngoscopy and bronchoscopy during the follow-up period and suprastomal granuloma formation was detected in 31.2% of these patients. 9 patients underwent decannulation at a median of 2 years from original tracheostomy placement. CONCLUSION Pediatric patients under the age of 2 undergoing tracheostomy exhibit high morbidity during both the initial hospital admission and the subsequent months following discharge. However, major complications were low and mortality was not directly related to tracheostomy status in any case.
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Affiliation(s)
| | - Zi Yang Jiang
- Department of Otorhinolaryngology-Head & Neck Surgery, McGovern Medical School at The University of Texas Health Science Center at Houston, Houston, TX, USA
| | | | - Sancak Yuksel
- Department of Otorhinolaryngology-Head & Neck Surgery, McGovern Medical School at The University of Texas Health Science Center at Houston, Houston, TX, USA
| | - Soham Roy
- Department of Otorhinolaryngology-Head & Neck Surgery, McGovern Medical School at The University of Texas Health Science Center at Houston, Houston, TX, USA
| | - Zhen Huang
- Department of Otorhinolaryngology-Head & Neck Surgery, McGovern Medical School at The University of Texas Health Science Center at Houston, Houston, TX, USA.
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26
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Han SM, Watters KF, Hong CR, Edwards EM, Knell J, Morrow KA, Soll RF, Jaksic T, Horbar JD, Modi BP. Tracheostomy in Very Low Birth Weight Infants: A Prospective Multicenter Study. Pediatrics 2020; 145:peds.2019-2371. [PMID: 32098788 DOI: 10.1542/peds.2019-2371] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/05/2019] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVES In this study, we benchmark outcomes and identify factors associated with tracheostomy placement in infants of very low birth weight (VLBW). METHODS Data were prospectively collected on infants of VLBW (401-1500 g or gestational age of 22-29 weeks) born between 2006 and 2016 and admitted to 796 North American centers. Length of stay (LOS), mortality, associated surgical procedures, and comorbidities were assessed, and infants who received tracheostomy were compared with those who did not. Multivariable logistic regressions were performed to identify risk factors for tracheostomy placement and for mortality in those receiving tracheostomy. RESULTS Of 458 624 infants of VLBW studied, 3442 (0.75%) received tracheostomy. Infants with tracheostomy had a median (interquartile range) LOS of 226 (168-304) days and a mortality rate of 18.8%, compared with 58 (39-86) days and 8.3% for infants without tracheostomy. Independent risk factors associated with tracheostomy placement included male sex, birth weight <1001 g, African American non-Hispanic maternal race, chronic lung disease (CLD), intraventricular hemorrhage, patent ductus arteriosus ligation, and congenital neurologic, cardiac, and chromosomal anomalies. Among infants who received tracheostomy, male sex, birth weight <751 g, CLD, and congenital anomalies were independent predictors of mortality. CONCLUSIONS Infants of VLBW receiving tracheostomy had twice the risk of mortality and nearly 4 times the initial LOS of those without tracheostomy. CLD and congenital anomalies were the strongest predictors of tracheostomy placement and mortality. These benchmark data on tracheostomy in infants of VLBW should guide discussions with patient families and inform future studies and interventions.
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Affiliation(s)
- Sam M Han
- Department of Surgery and Center for Advanced Intestinal Rehabilitation, and
| | - Karen F Watters
- Department of Otolaryngology and Communication Enhancement, Harvard Medical School and Boston Children's Hospital, Boston, Massachusetts
| | - Charles R Hong
- Department of Surgery and Center for Advanced Intestinal Rehabilitation, and
| | - Erika M Edwards
- University of Vermont, Burlington, Vermont; and.,Vermont Oxford Network, Burlington, Vermont
| | - Jamie Knell
- Department of Surgery and Center for Advanced Intestinal Rehabilitation, and
| | | | - Roger F Soll
- University of Vermont, Burlington, Vermont; and.,Vermont Oxford Network, Burlington, Vermont
| | - Tom Jaksic
- Department of Surgery and Center for Advanced Intestinal Rehabilitation, and
| | - Jeffrey D Horbar
- University of Vermont, Burlington, Vermont; and.,Vermont Oxford Network, Burlington, Vermont
| | - Biren P Modi
- Department of Surgery and Center for Advanced Intestinal Rehabilitation, and
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27
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Bradley J, Lee GS, Peyton J. Anesthesia for shared airway surgery in children. Paediatr Anaesth 2020; 30:288-295. [PMID: 31898366 DOI: 10.1111/pan.13815] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2019] [Revised: 12/18/2019] [Accepted: 12/23/2019] [Indexed: 11/28/2022]
Abstract
Shared airway surgery in children is a complex, high-risk undertaking that requires continuous communication and cooperation between the anesthetic and surgical teams. Airway abnormalities commonly seen in children, the surgical options, and the anesthetic techniques that can be used to care for this vulnerable population are discussed. Many of these procedures were traditionally carried out using jet ventilation, or intermittent tracheal intubation, but increasingly spontaneously breathing "tubeless" techniques are being used. This review has been written from both the surgical and anesthetic perspective, highlighting the concerns that both specialties have in relation to the maintenance of surgical access and operating conditions, and the need for the provision of anesthesia, oxygenation, and ventilation where the airway is the primary site of operation.
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Affiliation(s)
- James Bradley
- Department of Anesthesiology, Critical Care and Pain Medicine, Boston Children's Hospital, Boston, MA, USA
| | - Gi Soo Lee
- Department of Otolaryngology and Communication Enhancement, Boston Children's Hospital, Boston, MA, USA.,Harvard Medical School, Boston, MA, USA
| | - James Peyton
- Department of Anesthesiology, Critical Care and Pain Medicine, Boston Children's Hospital, Boston, MA, USA.,Harvard Medical School, Boston, MA, USA
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28
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Shin HI, Shin HI. Delayed Development of Head Control and Rolling in Infants With Tracheostomies. Front Pediatr 2020; 8:571573. [PMID: 33194899 PMCID: PMC7661431 DOI: 10.3389/fped.2020.571573] [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: 06/11/2020] [Accepted: 10/06/2020] [Indexed: 11/13/2022] Open
Abstract
Objective: Advances in neonatal care lead to an increased survival rate of critically ill babies. Infantile tracheostomies are not uncommon. However, only a few studies have addressed the effect of infant tracheostomy on early motor function. By comparing the scores of the Gross Motor Function Measure-88 (GMFM) on head control and rolling of infants with and without tracheostomies, the authors aimed to evaluate the effect of infant tracheostomy on early motor development. Methods: Medical records and the GMFM of subjects were retrospectively reviewed. Thirty-three infants with tracheostomies and 132 infants without tracheostomies were matched by gestational age, birth weight, and corrected age when the GMFM was performed using propensity score matching. GMFM scores in head control and rolling in different positions were compared by using generalized estimating equation (GEE). Results: Infants with tracheostomy showed lower values for head control in the supine position and in the pull to sit maneuver in multivariate GEE (p = 0.008, 0.004, respectively). However, the results of head control in a prone position and head lift while the examiner held the thorax showed no difference between the groups. Rolling from prone to supine was delayed in the infants with tracheostomy (p = 0.002), while rolling from supine to prone was not delayed compared to the non-tracheostomized group. More than half (54%) of the tracheostomy group scored better in rolling from a prone to supine position than in head control in supine position, which was a higher ratio compared to the non-tracheostomy group (p = 0.00). Conclusions: Tracheostomy seems to influence early motor development in infants. In particular, head control skills related to neck flexor muscle activation and rolling from prone to supine were delayed. Interventions may be required to facilitate these activities.
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Affiliation(s)
- Hyun Iee Shin
- Department of Rehabilitation Medicine, Chung-Ang University College of Medicine, Seoul, South Korea
| | - Hyung-Ik Shin
- Department of Rehabilitation Medicine, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, South Korea
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29
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Chia AZH, Ng ZM, Pang YX, Ang AHC, Chow CCT, Teoh OH, Lee JH. Epidemiology of Pediatric Tracheostomy and Risk Factors for Poor Outcomes: An 11-Year Single-Center Experience. Otolaryngol Head Neck Surg 2019; 162:121-128. [PMID: 31739743 DOI: 10.1177/0194599819887096] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE Children with long-term tracheostomies are at higher risk of complications. This study aims to describe the epidemiology, outcomes, and factors associated with successful decannulation in children undergoing tracheostomy. STUDY DESIGN Case series with chart review. SETTING Tertiary hospital. SUBJECTS AND METHODS A retrospective analysis was conducted on pediatric tracheostomies performed from 2006 to 2016. Demographics, preexisting comorbidities, indications for tracheostomy, and pretracheostomy ventilatory requirements were collected. A multivariate regression model with covariates of age, failure to thrive (FTT), and comorbidities was used to identify factors associated with successful decannulation. Secondary outcomes were ventilation and oxygen requirements at hospital discharge, hospital and intensive care unit length of stay, and complications. RESULTS In total, 105 patients received a tracheostomy at a median age of 8.0 months (interquartile range, 2.0-45.0). The most common indication was anatomic airway obstruction (55 of 105, 52.5%). Forty-four (41.9%) patients had preexisting FTT. In-hospital mortality was 14 of 105 (13.3%). None were directly related to tracheostomy. At discharge, 40 of 91 (44.0%) and 12 of 91 (13.2%) required home mechanical ventilation and supplemental oxygen, respectively. Forty-one (39%) patients underwent successful decannulation at a median 408 days (interquartile range, 170-1153) posttracheostomy. On adjusted analysis, unsuccessful decannulation was more common in patients with FTT and neurologic comorbidities. Postoperative complications were more common in younger patients and those with a longer time to decannulation. CONCLUSION Neurologic comorbidities and FTT were risk factors for unsuccessful decannulation after pediatric tracheostomy. Nutritional interventions may have a role in improving long-term outcomes following pediatric tracheostomies and should be investigated in future studies.
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Affiliation(s)
- Aletheia Z H Chia
- Lee Kong Chian School of Medicine, National Technological University, Singapore
| | - Zhi Min Ng
- Department of Paediatrics, KK Women's and Children's Hospital, Singapore
| | - Yu Xian Pang
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Annette H C Ang
- Department of Otolaryngology, KK Women's and Children's Hospital, Singapore
| | - Cristelle C T Chow
- Department of Paediatrics, KK Women's and Children's Hospital, Singapore
| | - Oon Hoe Teoh
- Department of Paediatrics, KK Women's and Children's Hospital, Singapore
| | - Jan Hau Lee
- Children's Intensive Care Unit, KK Women's and Children's Hospital, Singapore.,Duke-NUS Medical School, Singapore
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30
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Manning A, Wehrmann DJ, Hart CK, Green GE. Innovations in Airway Surgery. Otolaryngol Clin North Am 2019; 52:923-936. [DOI: 10.1016/j.otc.2019.06.005] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
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31
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Wang CS, Kou YF, Shah GB, Mitchell RB, Johnson RF. Tracheostomy in Extremely Preterm Neonates in the United States: A Cross-Sectional Analysis. Laryngoscope 2019; 130:2056-2062. [PMID: 31532845 DOI: 10.1002/lary.28304] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2019] [Revised: 07/30/2019] [Accepted: 08/27/2019] [Indexed: 12/18/2022]
Abstract
OBJECTIVES/HYPOTHESIS Bronchopulmonary dysplasia (BPD) and invasive respiratory support is increasing among extremely preterm neonates. Yet, it is unclear if there is a corresponding increase in tracheostomies. We hypothesize that in extremely preterm neonates with BPD, the incidence of tracheostomy has increased. STUDY DESIGN Retrospective cross-sectional analysis. METHODS We analyzed the 2006 to 2012 Kids' Inpatient Databases (KID) for hospital discharges of nonextremely preterm neonates (gestational age >28 weeks and <37 weeks or birth weight >1,500 g) and extremely preterm neonates (gestational age ≤28 weeks or birth weight ≤1,500 g). We studied tracheostomy placement trends in these two populations to see if they are increasing among extremely preterm neonates, especially those with BPD. RESULTS The study included 1,418,681 preterm neonates (52% male, 50% white, 19% black, 20% Hispanic, 4.2% Asian), of whom 118,676 (8.4%) were extremely preterm. A total of 2,029 tracheostomies were performed, of which 803 (0.68%) were in extremely preterm neonates. The estimated percent change of occurrence of extremely preterm neonates with BPD increased 17% between 2006 and 2012, and tracheostomy placement increased 31%. Amongst all who received tracheostomies, mortality rate was higher in extremely preterm neonates compared to nonextremely preterm neonates (18% vs. 14%, P = .05). However, in extremely preterm neonates, those with tracheostomies had a lower mortality rate compared to those without (18% vs. 24%, P = .002). CONCLUSIONS Extremely preterm neonates, compared to nonextremely preterm neonates, experienced a marked increase in tracheostomies placed from 2006 to 2012 as well as an increased incidence of BPD, confirming our primary study hypothesis. LEVEL OF EVIDENCE 4 Laryngoscope, 130: 2056-2062, 2020.
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Affiliation(s)
- Cynthia S Wang
- Department of Otolaryngology-Head and Neck Surgery, Division of Pediatric Otolaryngology, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Yann-Fuu Kou
- Department of Otolaryngology-Head and Neck Surgery, Division of Pediatric Otolaryngology, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Gopi B Shah
- Department of Otolaryngology-Head and Neck Surgery, Division of Pediatric Otolaryngology, University of Texas Southwestern Medical Center, Dallas, Texas.,Department of Pediatric Otolaryngology, Children's Health, Children's Medical Center Dallas, Dallas, Texas, U.S.A
| | - Ron B Mitchell
- Department of Otolaryngology-Head and Neck Surgery, Division of Pediatric Otolaryngology, University of Texas Southwestern Medical Center, Dallas, Texas.,Department of Pediatric Otolaryngology, Children's Health, Children's Medical Center Dallas, Dallas, Texas, U.S.A
| | - Romaine F Johnson
- Department of Otolaryngology-Head and Neck Surgery, Division of Pediatric Otolaryngology, University of Texas Southwestern Medical Center, Dallas, Texas.,Department of Pediatric Otolaryngology, Children's Health, Children's Medical Center Dallas, Dallas, Texas, U.S.A
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32
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Roberts J, Powell J, Begbie J, Siou G, McLarnon C, Welch A, McKean M, Thomas M, Ebdon A, Moss S, Agbeko RS, Smith JH, Brodlie M, O'Brien C, Powell S. Pediatric tracheostomy: A large single‐center experience. Laryngoscope 2019; 130:E375-E380. [DOI: 10.1002/lary.28160] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2019] [Revised: 05/23/2019] [Accepted: 06/12/2019] [Indexed: 12/12/2022]
Affiliation(s)
- Jessica Roberts
- Institute of Cellular MedicineNewcastle University Newcastle upon Tyne United Kingdom
- Department of Paediatric OtolaryngologyGreat North Children's Hospital Newcastle upon Tyne United Kingdom
| | - Jason Powell
- Institute of Cellular MedicineNewcastle University Newcastle upon Tyne United Kingdom
- Department of Paediatric OtolaryngologyGreat North Children's Hospital Newcastle upon Tyne United Kingdom
| | - Jacob Begbie
- Department of Paediatric OtolaryngologyGreat North Children's Hospital Newcastle upon Tyne United Kingdom
| | - Gerard Siou
- Department of Paediatric OtolaryngologyGreat North Children's Hospital Newcastle upon Tyne United Kingdom
| | - Claire McLarnon
- Department of Paediatric OtolaryngologyGreat North Children's Hospital Newcastle upon Tyne United Kingdom
| | - Andrew Welch
- Department of Paediatric OtolaryngologyGreat North Children's Hospital Newcastle upon Tyne United Kingdom
| | - Michael McKean
- Department of Paediatric Respiratory MedicineGreat North Children's Hospital Newcastle upon Tyne United Kingdom
| | - Mathew Thomas
- Institute of Cellular MedicineNewcastle University Newcastle upon Tyne United Kingdom
- Department of Paediatric Respiratory MedicineGreat North Children's Hospital Newcastle upon Tyne United Kingdom
| | - Anne‐Marie Ebdon
- Department of Paediatric Respiratory MedicineGreat North Children's Hospital Newcastle upon Tyne United Kingdom
| | - Samantha Moss
- Department of Paediatric Respiratory MedicineGreat North Children's Hospital Newcastle upon Tyne United Kingdom
| | - Rachel S. Agbeko
- Institute of Cellular MedicineNewcastle University Newcastle upon Tyne United Kingdom
- Department of Paediatric Anaesthesia and Intensive CareGreat North Children's Hospital Newcastle upon Tyne United Kingdom
| | - Jonathan H. Smith
- Department of Paediatric Cardiothoracic Anaesthesia and Intensive CareFreeman Hospital Newcastle upon Tyne United Kingdom
| | - Malcolm Brodlie
- Institute of Cellular MedicineNewcastle University Newcastle upon Tyne United Kingdom
- Department of Paediatric Respiratory MedicineGreat North Children's Hospital Newcastle upon Tyne United Kingdom
| | - Christopher O'Brien
- Department of Paediatric Respiratory MedicineGreat North Children's Hospital Newcastle upon Tyne United Kingdom
| | - Steven Powell
- Department of Paediatric OtolaryngologyGreat North Children's Hospital Newcastle upon Tyne United Kingdom
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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.
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Greenberg RG, Gayam S, Savage D, Tong A, Gorham D, Sholomon A, Clark RH, Benjamin DK, Laughon M, Smith PB. Furosemide Exposure and Prevention of Bronchopulmonary Dysplasia in Premature Infants. J Pediatr 2019; 208:134-140.e2. [PMID: 30579586 PMCID: PMC6486845 DOI: 10.1016/j.jpeds.2018.11.043] [Citation(s) in RCA: 38] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2018] [Revised: 10/31/2018] [Accepted: 11/26/2018] [Indexed: 12/22/2022]
Abstract
OBJECTIVE To evaluate the association between furosemide exposure and risk of bronchopulmonary dysplasia (BPD). STUDY DESIGN This retrospective cohort study included infants (2004-2015) born at 23-29 weeks gestational age and 501-1249 g birth weight. We compared the demographic and clinical characteristics of infants exposed and not exposed to furosemide between postnatal day 7 and 36 weeks postmenstrual age. We examined the association between furosemide exposure and 2 outcomes: BPD and BPD or death. We performed multivariable probit regression models that included demographic and clinical variables in addition to 2 instrumental variables: furosemide exposure by discharge year, and furosemide exposure by site. RESULTS Of 37 693 included infants, 19 235 (51%) were exposed to furosemide; these infants were more premature and had higher respiratory support. Of 33 760 infants who survived to BPD evaluation, 15 954 (47%) had BPD. An increase in the proportion of furosemide exposure days by 10 percentage points was associated with a decrease in both the incidence of BPD (4.6 percentage points; P = .001), and BPD or death (3.7 percentage points; P = .01). CONCLUSIONS More days of furosemide exposure between postnatal day 7 and 36 weeks was associated with decreased risk of BPD and a combined outcome of BPD or death.
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Affiliation(s)
- Rachel G Greenberg
- Department of Pediatrics, Duke University School of Medicine, Durham, NC; Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC.
| | - Sreepriya Gayam
- Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC
| | - Destiny Savage
- Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC
| | - Andrew Tong
- Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC
| | - Daniel Gorham
- Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC
| | - Ari Sholomon
- Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC
| | - Reese H Clark
- Pediatrix-Obstetrix Center for Research and Education, Sunrise, FL
| | | | - Matthew Laughon
- Department of Pediatrics, The University of North Carolina-Chapel Hill, Chapel Hill, NC
| | - P Brian Smith
- Department of Pediatrics, Duke University School of Medicine, Durham, NC; Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC
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Kurata H, Ochiai M, Inoue H, Ichiyama M, Yasuoka K, Fujiyoshi J, Matsushita Y, Honjo S, Sakai Y, Ohga S. A nationwide survey on tracheostomy for very-low-birth-weight infants in Japan. Pediatr Pulmonol 2019; 54:53-60. [PMID: 30525314 DOI: 10.1002/ppul.24200] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2018] [Accepted: 10/12/2018] [Indexed: 01/06/2023]
Abstract
OBJECTIVES Tracheostomy is indicated for very-low-birth-weight infants (VLBWIs) with prolonged respiratory problems during the perinatal period. The objective of this study is to clarify the epidemiology and risk factors in VLBWIs with tracheostomy after birth in Japan. METHODS A total of 40 806 VLBWIs were registered in the Neonatal Research Network of Japan database from 2003 to 2012. Among them, 34 674 infants (85%) survived over 28 days after birth and were subjected to this study. The clinical variables at birth, outcomes at hospital discharge and associated factors for tracheostomy were examined. RESULTS The proportion of VLBWIs with tracheostomy did not increase during the study period (mean 36 cases per year, 0.93%). The rate of in-hospital death over 28 days after birth did not differ between tracheostomized and non-tracheostomized infants (2/324, 0.6% vs 314/34 350, 0.9%). Tracheostomized infants more frequently had severe or moderate bronchopulmonary dysplasia (BPD) (75.5% vs 26.0%, P < 0.01) and longer hospitalization (229 days vs 83 days, P < 0.01) than non-tracheostomized infants. Tracheostomized patients showed higher comorbidities with hypoxic ischemic encephalopathy (odds ratio [OR] 10.98, P < 0.01), muscular disease (OR 10.95, P < 0.01), severe or moderate BPD (OR 7.79, P < 0.01), chromosomal abnormality (OR 4.43, P < 0.01) or sepsis (OR 1.78, P < 0.05) at hospital discharge than non-tracheostomized patients. CONCLUSION We demonstrated the non-increasing rate in tracheostomy for VLBWIs and such cases were associated with an excellent survival in Japan. These data provide evidence that more attentive care must be practiced in order to reduce the pulmonary and neuromuscular burdens of VLBWIs at birth.
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Affiliation(s)
- Hiroaki Kurata
- Department of Pediatrics, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan.,Comprehensive Maternity and Perinatal Care Center, Kyushu University, Fukuoka, Japan
| | - Masayuki Ochiai
- Department of Pediatrics, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan.,Comprehensive Maternity and Perinatal Care Center, Kyushu University, Fukuoka, Japan
| | - Hirosuke Inoue
- Department of Pediatrics, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan.,Comprehensive Maternity and Perinatal Care Center, Kyushu University, Fukuoka, Japan
| | - Masako Ichiyama
- Department of Pediatrics, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan.,Comprehensive Maternity and Perinatal Care Center, Kyushu University, Fukuoka, Japan
| | - Kazuaki Yasuoka
- Department of Pediatrics, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan.,Comprehensive Maternity and Perinatal Care Center, Kyushu University, Fukuoka, Japan
| | - Junko Fujiyoshi
- Department of Pediatrics, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan.,Comprehensive Maternity and Perinatal Care Center, Kyushu University, Fukuoka, Japan
| | - Yuki Matsushita
- Department of Pediatrics, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan.,Comprehensive Maternity and Perinatal Care Center, Kyushu University, Fukuoka, Japan
| | - Satoshi Honjo
- Department of Pediatrics, National Hospital Organization Fukuoka Hospital, Fukuoka, Japan
| | - Yasunari Sakai
- Department of Pediatrics, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Shouichi Ohga
- Department of Pediatrics, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
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Kim K, Yoon JS. Tracheostomy in children: A 9-year experience in a tertiary hospital in Korea. ALLERGY ASTHMA & RESPIRATORY DISEASE 2019. [DOI: 10.4168/aard.2019.7.3.137] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Affiliation(s)
- Kyunghoon Kim
- Department of Pediatrics, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Jong-Seo Yoon
- Department of Pediatrics, College of Medicine, The Catholic University of Korea, Seoul, Korea
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Abstract
Neonatal and infant tracheostomies have been valuable in the care and survival of children over the past century. With the implementation of neonatal and pediatric intensive care units, more infants are surviving conditions that were considered fatal. Neonatal tracheostomy plays a vital role in many of these conditions, with significant implications and association with overall mortality, morbidity, and developmental outcomes. Although the technique has not changed much, there have been significant evolutions in indications, survival, complications, and technological advances. Improved outcomes research to decrease the high associated morbidities is needed.
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Affiliation(s)
- Jonathan Walsh
- Department of Otolaryngology Head and Neck Surgery, Johns Hopkins School of Medicine, 601 North Caroline Street, 6th Floor, Baltimore, MD 21287, USA.
| | - Jeffrey Rastatter
- Ann & Robert H. Lurie Children's Hospital of Chicago, Box 25, 225 E Chicago Avenue, Chicago, IL 60611, USA
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Doherty C, Neal R, English C, Cooke J, Atkinson D, Bates L, Moore J, Monks S, Bowler M, Bruce IA, Bateman N, Wyatt M, Russell J, Perkins R, McGrath BA. Multidisciplinary guidelines for the management of paediatric tracheostomy emergencies. Anaesthesia 2018; 73:1400-1417. [PMID: 30062783 DOI: 10.1111/anae.14307] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/14/2018] [Indexed: 01/09/2023]
Abstract
Temporary and permanent tracheostomies are required in children to manage actual or anticipated long-term ventilatory support, to aid secretion management or to manage fixed upper airway obstruction. Tracheostomies may be required from the first few moments of life, with the majority performed in children < 4 years of age. Although similarities with adult tracheostomies are apparent, there are key differences when managing the routine and emergency care of children with tracheostomies. The National Tracheostomy Safety Project identified the need for structured guidelines to aid multidisciplinary clinical decision making during paediatric tracheostomy emergencies. These guidelines describe the development of a bespoke emergency management algorithm and supporting resources. Our aim is to reduce the frequency, nature and severity of paediatric tracheostomy emergencies through preparation and education of staff, parents, carers and patients.
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Affiliation(s)
- C Doherty
- Department of Paediatric Anaesthesia, Manchester University NHS Foundation Trust, Manchester, UK
| | - R Neal
- Paediatric Intensive Care Medicine, Paediatrics, Birmingham Children's Hospital, Birmingham, UK
| | - C English
- Department of Paediatric ENT, Manchester University NHS Foundation Trust, Manchester, UK
| | - J Cooke
- Department of Paediatric Otolaryngology, Great Ormond Street Hospital, London, UK
| | - D Atkinson
- Department of Anaesthesia and Intensive Care Medicine, Manchester University NHS Foundation Trust, Manchester, UK
| | - L Bates
- Department of Anaesthesia and Intensive Care Medicine, Royal Bolton Hospital, Bolton, UK
| | - J Moore
- Department of Anaesthesia and Intensive Care Medicine, Manchester University NHS Foundation Trust, Manchester, UK
| | - S Monks
- Department of Anaesthesia, East Lancashire Hospitals NHS Trust, Burnley, UK
| | - M Bowler
- Department of Paediatric Anaesthesia, Manchester University NHS Foundation Trust, Manchester, UK
| | - I A Bruce
- Department of Paediatric Otolaryngology, Royal Manchester Children's Hospital, Manchester, UK
- Manchester Academic Health Science Centre, Manchester, UK
- Division of Infection, Immunity and Respiratory Medicine, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
| | - N Bateman
- Department of Paediatric Otolaryngology, Royal Manchester Children's Hospital, Manchester, UK
| | - M Wyatt
- Department of Paediatric Otolaryngology, Great Ormond Street Hospital, London, UK
| | - J Russell
- Department of Paediatric ENT, Our Lady's Children's Hospital, Dublin, Ireland
| | - R Perkins
- Department of Paediatric Anaesthesia, Manchester University NHS Foundation Trust, Manchester, UK
| | - B A McGrath
- Department of Anaesthesia and Intensive Care Medicine, Manchester University NHS Foundation Trust, Manchester, UK
- Division of Infection, Immunity and Respiratory Medicine, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
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Muller RG, Mamidala MP, Smith SH, Smith A, Sheyn A. Incidence, Epidemiology, and Outcomes of Pediatric Tracheostomy in the United States from 2000 to 2012. Otolaryngol Head Neck Surg 2018; 160:332-338. [PMID: 30348050 DOI: 10.1177/0194599818803598] [Citation(s) in RCA: 72] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVES To investigate national and regional variations in pediatric tracheostomy rates, epidemiology, and outcomes from 2000 to 2012. STUDY DESIGN Retrospective cohort analysis. SETTING Previous research with the 1997 edition of the Kids' Inpatient Database (KID), a national database of pediatric hospital discharge data, demonstrated that rates and outcomes of pediatric tracheostomy vary among US geographic regions. The KID has since been released an additional 5 times, increasing in size with successive editions. SUBJECTS AND METHODS Patients ≤18 years old with procedure codes for permanent or temporary tracheostomy from 2000 to 2012 were included. Primary outcome was a weighted population-based rate of tracheostomy stratified by year. Secondary analysis included epidemiologic characteristics and outcomes stratified by year and geographic region. RESULTS A weighted total of 24,354 cases was analyzed. Population-based tracheostomy rates decreased from 6.8 ± 0.2 (mean ± SD) tracheostomies per 100,000 child-years in 2000 to 6.0 ± 0.2 in 2012. Minorities increased from 53.3% in 2000 to 56.4% in 2012. Patients experienced increased procedures, diagnoses, length of stay, and hospital charges with time. From 2000 to 2012, rates and outcomes varied by US geographic region. Mortality during hospitalization (8%) did not vary by year, patient age, region, or sex. CONCLUSIONS Pediatric tracheostomy is associated with variation in incidence, epidemiology, and hospitalization outcomes in the United States from 2000 to 2012. While rates of pediatric tracheostomy decreased, patients became increasingly medically complicated and ethnically diverse with outcomes varying according to geographic region.
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Affiliation(s)
- R Grant Muller
- 1 College of Medicine, University of Tennessee Health Science Center, Memphis, Tennessee, USA
| | - Madhu P Mamidala
- 1 College of Medicine, University of Tennessee Health Science Center, Memphis, Tennessee, USA
| | - Samuel H Smith
- 1 College of Medicine, University of Tennessee Health Science Center, Memphis, Tennessee, USA.,2 Le Bonheur Children's Hospital, Memphis, Tennessee, USA
| | - Aaron Smith
- 1 College of Medicine, University of Tennessee Health Science Center, Memphis, Tennessee, USA.,2 Le Bonheur Children's Hospital, Memphis, Tennessee, USA
| | - Anthony Sheyn
- 1 College of Medicine, University of Tennessee Health Science Center, Memphis, Tennessee, USA.,2 Le Bonheur Children's Hospital, Memphis, Tennessee, USA
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Reduction of Analgesia Duration after Tracheostomy during Neonatal Intensive Care: A Quality Initiative. Pediatr Qual Saf 2018; 3:e106. [PMID: 30584633 PMCID: PMC6221593 DOI: 10.1097/pq9.0000000000000106] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2018] [Accepted: 08/05/2018] [Indexed: 01/30/2023] Open
Abstract
Introduction As survival has improved in the Neonatal Intensive Care Unit (NICU), there has been a 10-fold increase in the proportion of infants requiring a tracheostomy. At our institution, we observed a wide variation in the duration of opioid use posttracheostomy from 6 to 148 days. We aimed to decrease the duration of opioid exposure in postoperative tracheostomy patients in the NICU from a baseline average of 24 days to 7 days by December 31, 2017. Methods We established a multidisciplinary team to develop change ideas to implement in 3 Plan-Do-Study-Act cycles that focused on enhanced care plan standardization and communication in patient care rounds with subsequent documentation in the medical record and the timely addition of dexmedetomidine to the postoperative care plan. Results Baseline population was from October 2014 to December 2016. The mean posttracheostomy opioid duration was 24.6 days (range, 6-148 days); neuromuscular blockade was 2.89 days (range, 0-9 days), and benzodiazepine exposure was 20.9 days (range, 1-114 days). Following our interventions, the mean duration of posttracheostomy opioid duration was 5.4 days (range, 4-21 days); neuromuscular blockade was 3.14 days (range, 1-5 days), benzodiazepine duration was 8.88 days (range, 4-25 days), and dexmedetomidine was 4.6 days (range, 0-32 days). Conclusions We utilized quality improvement methodology to standardize posttracheostomy management and demonstrate that we could significantly reduce the duration of opioid and benzodiazepine use after tracheostomy with the timely addition of dexmedetomidine, a structured written daily care plan, and clarification of roles and responsibilities.
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Rawal RB, Farquhar DR, Kilpatrick LA, Drake AF, Zdanski CJ. Considering a Weight Criterion for Neonatal Tracheostomy: An Analysis of the ACS NSQIP-P. Laryngoscope 2018; 129:500-505. [PMID: 30194839 DOI: 10.1002/lary.27272] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/09/2018] [Indexed: 11/06/2022]
Abstract
OBJECTIVES Neonates weighing < 2.5 kg have known higher rates of surgical mortality and morbidity, but this remains unexamined specifically for tracheostomy. We present outcomes of neonates undergoing tracheostomy stratified by weight. METHODS Retrospective review of the American College of Surgeons National Surgical Quality Improvement Program-Pediatric from 2012 to 2014. Patients undergoing tracheostomy were included. Thirty-day mortality and major/minor complication rates were stratified by weight (group 1: < 2.5 kg; group 2: ≥ 2.5 kg and < 4 kg; group 3: ≥ 4 kg). Patient comorbidities were assessed for independent risk factors of morbidity and mortality. RESULTS Of 183,233 patients, 543 underwent tracheostomy. Forty-four patients were group 1 (mean: 2.2 kg ± 0.25); 170 patients were group 2 (mean: 3.31 kg ± 0.42); and 329 patients were group 3 (mean: 6.4 kg ± 2.7). Between groups 1 and 2, there were no significant differences in mortality (P = 0.47), major complication rates (P = 0.99), or minor complication rates (P = 0.64). In comparing all three groups, there were no significant differences in mortality (P = 0.47), major complication rates (P = 0.80), or minor complication rates (P = 0.77). The overall 30-day mortality for all patients was 4.24%. In a multivariate logistical regression model, weight group did not change the odds of all negative outcomes (group 1: odds ratio [OR] of 0.71; 95% confidence interval [CI], 0.33-1.53 and group 2: OR of 0.78; 95% CI, 0.50-1.22). Bronchopulmonary dysplasia was the only independent significant predictor of major complications (OR, 1.69; 95% CI, 1.02-2.79) (P = 0.04). CONCLUSION Our data indicate that 30-day mortality and morbidity outcomes for neonatal tracheostomy are not affected by weight. Overall 30-day mortality should be discussed with caregivers preoperatively. LEVEL OF EVIDENCE 4 Laryngoscope, 129:500-505, 2019.
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Affiliation(s)
- Rounak B Rawal
- Department of Otolaryngology/Head and Neck Surgery, University of North Carolina-Chapel Hill, Chapel Hill, North Carolina, U.S.A
| | - Douglas R Farquhar
- Department of Otolaryngology/Head and Neck Surgery, University of North Carolina-Chapel Hill, Chapel Hill, North Carolina, U.S.A
| | - Lauren A Kilpatrick
- Department of Otolaryngology/Head and Neck Surgery, University of North Carolina-Chapel Hill, Chapel Hill, North Carolina, U.S.A
| | - Amelia F Drake
- Department of Otolaryngology/Head and Neck Surgery, University of North Carolina-Chapel Hill, Chapel Hill, North Carolina, U.S.A
| | - Carlton J Zdanski
- Department of Otolaryngology/Head and Neck Surgery, University of North Carolina-Chapel Hill, Chapel Hill, North Carolina, U.S.A
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Sanders CD, Guimbellot JS, Muhlebach MS, Lin FC, Gilligan P, Esther CR. Tracheostomy in children: Epidemiology and clinical outcomes. Pediatr Pulmonol 2018; 53:1269-1275. [PMID: 29968973 DOI: 10.1002/ppul.24071] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2018] [Accepted: 01/30/2018] [Indexed: 11/07/2022]
Abstract
BACKGROUND Tracheotomy is performed in children for a variety of indications, but can place them at increased risk of lower airway infection with pathogenic organisms. While prior studies have identified Pseudomonas aeruginosa and Staphylococcus aureus as the most common lower airway pathogens in children with tracheostomies, little is known about the clinical implications of chronic growth of pathogens. METHODS The North Carolina Children's Airway Center database was utilized to identify all pediatric patients with tracheostomy from 2007 to 2012; these data were cross-referenced to a microbiology database of all tracheostomy cultures. Data on hospitalizations, intensive care unit admissions, and length-of-stay were abstracted from the medical record and analyzed using multivariate methods. RESULTS We identified 185 children with tracheostomy, of whom chronic bacterial growth status could be defined in 69. P aeruginosa was a common pathogen isolated from tracheostomy cultures, with 49% (91/185) of patients growing this organism at least once. P aeruginosa combined with other gram-negative rods were isolated in 63% (116/185) of subjects at least once. Those who chronically grew gram-negative rods had significantly more hospitalizations, longer total lengths-of-stay, and longer intensive care unit lengths-of-stay than those who did not. These differences remained significant when data were normalized to account for number of available cultures. CONCLUSION These data suggest that clinical outcomes may be worse in children with tracheostomies who chronically grow gram-negative rods. Our findings may help guide clinicians in managing children with tracheostomies, though further studies are needed to establish best practice guidelines in these patients.
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Affiliation(s)
- Catherine D Sanders
- Department of Pediatrics, Division of Pulmonology, University of Tennessee Health Science Center, Memphis, Tennessee
| | - Jennifer S Guimbellot
- Department of Pediatrics, Division of Pulmonary and Sleep Medicine, University of Alabama at Birmingham, Birmingham, Alabama
| | - Marianne S Muhlebach
- Department of Pediatrics, Division of Pulmonology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Feng-Chang Lin
- Department of Biostatistics, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Peter Gilligan
- Department of Pathology and Laboratory Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Charles R Esther
- Department of Pediatrics, Division of Pulmonology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
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Giambra BK, Mangeot C, Benscoter DT, Britto MT. Identification of hospitalized tracheostomy and ventilator dependent patients in administrative data. Pediatr Pulmonol 2018; 53:973-978. [PMID: 29766676 DOI: 10.1002/ppul.24054] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2017] [Accepted: 04/20/2018] [Indexed: 11/12/2022]
Abstract
BACKGROUND Patients with established tracheostomy and ventilator dependence are hospitalized more frequently and use more healthcare resources than other patients with complex chronic conditions. However, data to compare variation in hospitalization and resource use among patients in this population across the United States is deficient, partly due to the lack of structured methods to query national databases. AIM Determine the best method for identifying the subset of children with established tracheostomy and ventilator dependence in Pediatric Health Information System (PHIS). HYPOTHESIS A combination of identifiable characteristics coded in the PHIS database can be used to identify the population of patients with established tracheostomy and ventilator dependence who are admitted to the hospital. METHODS This cross-sectional, retrospective cohort study used established methods to extract data from PHIS and assessed the sensitivity and specificity of an algorithm to identify patients with established tracheostomy and ventilator dependence as compared with a local registry of ventilator dependent patients. RESULTS A newly created algorithm identified >90% of the 157 patients with established tracheostomy and ventilator dependence hospitalized at our organization during 2014. The sensitivity and specificity of the algorithm to identify these patients was 91% and 99%, respectively. CONCLUSIONS This new algorithm can be used to reliably identify and further study healthcare utilization by this population of patients with established tracheostomy and ventilator dependence. In addition, future work can determine the applicability of this algorithm to other administrative datasets.
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Affiliation(s)
- Barbara K Giambra
- Research in Patient Services, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Colleen Mangeot
- Division of Biostatistics and Epidemiology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Dan T Benscoter
- Division of Pulmonary Medicine-Clinical, Respiratory Therapy Medical Director Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Maria T Britto
- Center for Innovation in Chronic Disease Care, James M. Anderson Center for Health Systems Excellence, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio.,Department of Pediatrics, University of Cincinnati, Cincinnati, Ohio
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Lapcharoensap W, Lee HC, Nyberg A, Dukhovny D. Health Care and Societal Costs of Bronchopulmonary Dysplasia. Neoreviews 2018; 19:e211-e223. [PMID: 33384574 DOI: 10.1542/neo.19-4-e211] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Despite significant technological advances and increasing survival of premature infants, bronchopulmonary dysplasia (BPD) continues to be the most prevalent major morbidity in surviving very low-birthweight infants. Infants with BPD are often sicker, require longer stays in the NICU, and accumulate greater hospital costs. However, care of the infant with BPD extends beyond the time spent in the NICU. This article reviews the costs of BPD in the health-care setting, during the initial hospitalization and beyond, and the long-term neurodevelopmental impact of BPD, as well as the impact on a family caring for a child with BPD.
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Affiliation(s)
| | - Henry C Lee
- Department of Pediatrics, Stanford University, Stanford, CA
| | - Amy Nyberg
- March of Dimes NICU Family Support Coordinator, Helen DeVos Children's Hospital, Grand Rapids, MI
| | - Dmitry Dukhovny
- Department of Pediatrics, Oregon Health and Science University, Portland, OR
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46
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Hebert LM, Watson AC, Madrigal V, October TW. Discussing Benefits and Risks of Tracheostomy: What Physicians Actually Say. Pediatr Crit Care Med 2017; 18:e592-e597. [PMID: 28938289 PMCID: PMC5716895 DOI: 10.1097/pcc.0000000000001341] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES When contemplating tracheostomy placement in a pediatric patient, a family-physician conference is often the setting for the disclosure of risks and benefits of the procedure. Our objective was to compare benefits and risks of tracheostomy presented during family-physician conferences to an expert panel's recommendations for what should be presented. DESIGN We conducted a retrospective review of 19 transcripts of audio-recorded family-physician conferences regarding tracheostomy placement in children. A multicenter, multidisciplinary expert panel of clinicians was surveyed to generate a list of recommended benefits and risks for comparison. Primary analysis of statements by clinicians was qualitative. SETTING Single-center PICU of a tertiary medical center. SUBJECTS Family members who participated in family-physician conferences regarding tracheostomy placement for a critically ill child from April 2012 to August 2014. MEASUREMENTS AND MAIN RESULTS We identified 300 physician statements describing benefits and risks of tracheostomy. Physicians were more likely to discuss benefits than risks (72% vs 28%). Three broad categories of benefits were identified: 1) tracheostomy would limit the impact of being in the PICU (46%); 2) perceived obstacles of tracheostomy can be overcome (34%); and 3) tracheostomy optimizes respiratory health (20%). Risks fell into two categories: tracheostomy involves a big commitment (71%), and it has complications (29%). The expert panel's recommendations were similar to risks and benefits discussed during family conferences; however, they suggested physicians present an equal balance of discussion of risks and benefits. CONCLUSIONS When discussing tracheostomy placement, physicians emphasized benefits that are shared by physicians and families while minimizing the risks. The expert panel recommended a balanced approach by equally weighing risks and benefits. To facilitate educated decision making, physicians should present a more extensive range of risks and benefits to families making this critical decision.
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Affiliation(s)
- Lauren M. Hebert
- Children’s Hospital at Memorial University Medical Center, Savannah, Georgia
- Mercer University School of Medicine Department of Pediatrics, Savannah, Georgia
| | - Anne C. Watson
- Children’s National Health Systems, Washington, District of Columbia
| | - Vanessa Madrigal
- Children’s National Health Systems, Washington, District of Columbia
- The George Washington University School of Medicine and Health Sciences Department of Pediatrics, Washington, District of Columbia
| | - Tessie W. October
- Children’s National Health Systems, Washington, District of Columbia
- The George Washington University School of Medicine and Health Sciences Department of Pediatrics, Washington, District of Columbia
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McPherson ML, Shekerdemian L, Goldsworthy M, Minard CG, Nelson CS, Stein F, Graf JM. A decade of pediatric tracheostomies: Indications, outcomes, and long-term prognosis. Pediatr Pulmonol 2017; 52:946-953. [PMID: 28263440 DOI: 10.1002/ppul.23657] [Citation(s) in RCA: 60] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2016] [Revised: 11/03/2016] [Accepted: 11/27/2016] [Indexed: 11/10/2022]
Abstract
OBJECTIVE To define the mortality and long-term outcomes of children undergoing tracheostomy. DESIGN Retrospective chart and Texas Department of Health Bureau of Vital Statistics review of patients admitted to a Pediatric Intensive Care Unit who underwent a tracheostomy between 2001 and 2011. Mortality and decannulation rates were compared based on tracheostomy indication and age. SUBJECTS A total of 426 patients admitted to a Pediatric Intensive Care Unit in a large tertiary children's hospital. RESULTS The median patient age was 1.5 years (3 days-24 years). Primary indications for tracheostomy included (a) airway obstruction, (b) congenital neurologic disease, (c) acquired neurologic disease, (d) congenital respiratory disease, and (e) acquired respiratory disease. Overall, 98 patients (23%) died during the study period, and 75th percentile survival time was 5.9 years (95%CI: 3-8). Patients undergoing a tracheostomy for airway obstruction were the least likely to die; while patients with acquired neurologic disease were most likely to die. A total of 163 patients (38%) were decannulated, and 50% were decannulated at 1.2 years (95%CI: 0.9-1.5). Patients with congenital neurologic disease were the least likely to undergo decannulation. Over half of the patients were discharged from the hospital requiring some form of mechanical respiratory support in addition to their tracheostomy. CONCLUSIONS In this largest cohort of long-term follow-up to date, we have shown the overall risk of mortality varied according to the indication for the tracheostomy. We were unable to determine exact causes of death. The likelihood of being decannulated also correlates with the underlying indication for the tracheostomy. Pediatr Pulmonol. 2017; 52:946-953. © 2017 Wiley Periodicals, Inc.
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Affiliation(s)
- Mona L McPherson
- Department of Pediatrics, Baylor College of Medicine, Texas Children's Hospital, Section of Critical Care Medicine, Fannin 6621, WT 6-006, Houston 77030, Texas
| | - Lara Shekerdemian
- Department of Pediatrics, Baylor College of Medicine, Texas Children's Hospital, Section of Critical Care Medicine, Fannin 6621, WT 6-006, Houston 77030, Texas
| | - Michelle Goldsworthy
- Department of Pediatrics, Baylor College of Medicine, Texas Children's Hospital, Section of Critical Care Medicine, Fannin 6621, WT 6-006, Houston 77030, Texas
| | - Charles G Minard
- Baylor College of Medicine, Dan L. Duncan Institute for Clinical and Translation Research, Houston, Texas
| | - Cynthia S Nelson
- Department of Pediatrics, Baylor College of Medicine, Texas Children's Hospital, Section of Critical Care Medicine, Fannin 6621, WT 6-006, Houston 77030, Texas
| | - Fernando Stein
- Department of Pediatrics, Baylor College of Medicine, Texas Children's Hospital, Section of Critical Care Medicine, Fannin 6621, WT 6-006, Houston 77030, Texas
| | - Jeanine M Graf
- Department of Pediatrics, Baylor College of Medicine, Texas Children's Hospital, Section of Critical Care Medicine, Fannin 6621, WT 6-006, Houston 77030, Texas
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Rutter MJ, Hart CK, Alarcon AD, Daniel SJ, Parikh SR, Balakrishnan K, Lam D, Johnson K, Sidell DR. Endoscopic anterior-posterior cricoid split for pediatric bilateral vocal fold paralysis. Laryngoscope 2017; 128:257-263. [DOI: 10.1002/lary.26547] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2016] [Revised: 12/14/2016] [Accepted: 01/27/2017] [Indexed: 11/11/2022]
Affiliation(s)
- Michael J. Rutter
- Division of Pediatric Otolaryngology-Head and Neck Surgery; Cincinnati Children's Hospital Medical Center; Cincinnati Ohio U.S.A
- Department of Otolaryngology-Head and Neck Surgery; University of Cincinnati College of Medicine; Cincinnati Ohio U.S.A
- Aerodigestive and Esophageal Center; Cincinnati Children's Hospital Medical Center; Cincinnati Ohio U.S.A
| | - Catherine K. Hart
- Division of Pediatric Otolaryngology-Head and Neck Surgery; Cincinnati Children's Hospital Medical Center; Cincinnati Ohio U.S.A
- Department of Otolaryngology-Head and Neck Surgery; University of Cincinnati College of Medicine; Cincinnati Ohio U.S.A
- Aerodigestive and Esophageal Center; Cincinnati Children's Hospital Medical Center; Cincinnati Ohio U.S.A
| | - Alessandro de Alarcon
- Division of Pediatric Otolaryngology-Head and Neck Surgery; Cincinnati Children's Hospital Medical Center; Cincinnati Ohio U.S.A
- Department of Otolaryngology-Head and Neck Surgery; University of Cincinnati College of Medicine; Cincinnati Ohio U.S.A
- Aerodigestive and Esophageal Center; Cincinnati Children's Hospital Medical Center; Cincinnati Ohio U.S.A
| | - Sam J. Daniel
- Department of Otolaryngology-Head and Neck Surgery; Montreal Children's Hospital, McGill University Health Centre; Montreal Quebec Canada
| | - Sanjay R. Parikh
- Department of Otolaryngology-Head and Neck Surgery; University of Washington School of Medicine and Seattle Children's Hospital; Seattle Washington U.S.A
| | - Karthik Balakrishnan
- Department of Otorhinolaryngology; Mayo Clinic College of Medicine; Rochester Minnesota U.S.A
| | - Derek Lam
- Division of Pediatric Otolaryngology; Oregon Health & Science University Doernbecher Children's Hospital, Oregon Health and Science University; Portland Oregon U.S.A
| | - Kaalan Johnson
- Department of Otolaryngology-Head and Neck Surgery; University of Washington School of Medicine and Seattle Children's Hospital; Seattle Washington U.S.A
| | - Douglas R. Sidell
- Department of Otolaryngology-Head and Neck Surgery; Division of Pediatric Otolaryngology, Lucile Packard Children's Hospital Stanford, Stanford University School of Medicine; Stanford California U.S.A
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Levit OL, Shabanova V, Bazzy-Asaad A, Bizzarro MJ, Bhandari V. Risk factors for tracheostomy requirement in extremely low birth weight infants. J Matern Fetal Neonatal Med 2017; 31:447-452. [PMID: 28139937 DOI: 10.1080/14767058.2017.1287895] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
AIM To identify variables that affect the risk of tracheostomy in a population of extremely low birth weight (ELBW) infants. METHODS A retrospective matched case-control study was conducted. ELBW infants with a tracheostomy were compared with controls without tracheostomy. Data collection included demographics, detailed information about each intubation and extubation attempt, the use of steroids and the presence of comorbidities. Statistical analyses include conditional logistic regression and Poisson regression for clustered observations. RESULTS Twenty-eight ELBW infants with a tracheostomy were identified. Mean gestational age for both cases and controls was 25 weeks (22-29) and 67.9% were males. Tracheostomy was performed on average on day of life 118 (95%CI: 107-128) and weight at tracheostomy was 2877 g (95%CI: 2657-3098). In the final model, cumulative days with an endotracheal tube (ETT) and total number of intubation episodes were associated with a tracheostomy. For each additional day of intubation, odds of tracheostomy increased by 11% (OR = 1.11, 95%CI: 1.01, 1.23) and with each new intubation episode/failed extubation episode, odds of tracheostomy increased by 150% from the previous episode (OR = 2.5, 95%CI: 1.2, 5.2). CONCLUSIONS Greater cumulative exposure to ETT ventilation and number of intubations is associated with having a tracheostomy.
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Affiliation(s)
- Orly L Levit
- a Department of Pediatrics , Yale University School of Medicine , New Haven , CT , USA
| | | | - Alia Bazzy-Asaad
- a Department of Pediatrics , Yale University School of Medicine , New Haven , CT , USA
| | - Matthew J Bizzarro
- a Department of Pediatrics , Yale University School of Medicine , New Haven , CT , USA
| | - Vineet Bhandari
- c Department of Pediatrics , Drexel University College of Medicine , Philadelphia , PA , USA
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