A decade of pediatric tracheostomies: Indications, outcomes, and long‐term prognosis

McPherson, Marianne E.; Shekerdemian, Lara; Goldsworthy, Michelle; Minard, Charles G.; Nelson, Cynthia S.; Stein, Fernando; Graf, Jeanine M.

doi:10.1002/ppul.23657

Cited by 73 publications

(108 citation statements)

References 30 publications

(46 reference statements)

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“…Overall 30‐day mortality for all patients was 4.24%, which is similar to previously published short‐term outcomes but less than previously published longer term outcomes, which were 8.9% to 29% . This difference is likely secondary to the morbid and chronic nature of the underlying etiology requiring the tracheostomy.…”

Section: Discussionsupporting

confidence: 75%

Considering a Weight Criterion for Neonatal Tracheostomy: An Analysis of the ACSNSQIP‐P

et al. 2018

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Section: Discussionsupporting

confidence: 75%

Considering a Weight Criterion for Neonatal Tracheostomy: An Analysis of the ACSNSQIP‐P

et al. 2018

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“…Simultaneously, there is some evidence decannulation rates are dropping, with recent reports suggesting rates as low as 25–38% (4,35–37), leading to an increased prevalence of children with tracheostomies.…”

Section: Discussionmentioning

confidence: 99%

“…PICU placed tracheostomies frequently result in decannulation, but tracheostomy placement is not without risk. Mortality is variable based on the indications for tracheostomy, with tracheostomy placement commonly offered to our most critically ill, complex diseased children (4,5). Families want to understand the benefits and risks of this critical decision to guide them in their ultimate choice, and presentation of this information should occur prior to consent.…”

Section: Introductionmentioning

confidence: 99%

Discussing Benefits and Risks of Tracheostomy: What Physicians Actually Say*

Hebert

Watson

Madrigal

et al. 2017

Pediatric Critical Care Medicine

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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 multi-center, multi-disciplinary 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 Pediatric Intensive Care Unit (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. Conclusion 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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“…UK Paediatric Intensive Care audit network database analysis shows that tracheostomy is performed infrequently in children admitted to PICU (2% of all admissions) and only 3.5% tracheostomised children had a cancer diagnosis . In the absence of any evidence‐based recommendations for indication and timing, tracheostomy for prolonged ventilatory support is often delayed due to risk of complications and 7‐22% risk of death of which 2% is attributed to tracheostomy . One‐third of clinicians in UK PICUs would delay tracheostomy because of worry about complications associated with tracheostomy .…”

Section: Discussionmentioning

confidence: 99%

“…Surgical tracheostomy in children is associated with high incidence (18‐50%) of complications including dislodgement, obstruction, haemorrhage, infection, granuloma formation, and emphysema . It is infrequently performed in Paediatric Intensive Care Unit (PICU) patients compared to adults due to clinicians’ worry about complications associated with the procedure .…”

Section: Introductionmentioning

confidence: 99%

Surgical tracheostomy in children with malignancy receiving intensive chemotherapy: A case series and review of literature

Manna¹,

Malik²,

Douthwaite³

et al. 2019

Pediatric Blood & Cancer

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We retrospectively reviewed a paediatric intensive care unit database that supports a tertiary oncology service to explore safety and outcome of tracheostomy in oncology patients over a 12‐year period and reviewed literature. A total of 895 patients were admitted with a haematological or a solid tumour malignancy of which 222 were ventilated. Six of 222 (2.7%) ventilated children were tracheostomised. Four of six children tracheostomised for ventilatory support received intensive chemotherapy complicated by neutropenia and thrombocytopenia. There was no significant tracheostomy‐related complication. Tracheostomy improved patient comfort, reduced sedative requirement, and may have helped recovery. Tracheostomy should be considered early in selected children with haemato‐oncological diagnoses requiring prolonged ventilation.

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A decade of pediatric tracheostomies: Indications, outcomes, and long‐term prognosis

Cited by 73 publications

References 30 publications

Considering a Weight Criterion for Neonatal Tracheostomy: An Analysis of the ACSNSQIP‐P

Considering a Weight Criterion for Neonatal Tracheostomy: An Analysis of the ACSNSQIP‐P

Discussing Benefits and Risks of Tracheostomy: What Physicians Actually Say*

Surgical tracheostomy in children with malignancy receiving intensive chemotherapy: A case series and review of literature

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