A randomized controlled trial of Velcro versus standard twill ties following pediatric tracheotomy

Hart, Catherine K.; Tawfik, Kareem O.; Meinzen‐Derr, Jareen; Prosser, J. Drew; Brumbaugh, Cheryl; Myer, Amy; Ward, Jonette A.; Alarcón, Alessandro de

doi:10.1002/lary.26608

Cited by 18 publications

(15 citation statements)

References 17 publications

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“…They have a smaller width and have a tendency to retain secretions compared to hook-and-loop cushioned ties. A randomized controlled trial [45] in 57 patients demonstrated no significant difference with respect to accidental decannulation or skin injury between traditional twill versus cushioned ties.…”

Section: Wound Carementioning

confidence: 98%

Update on Pediatric Tracheostomy: Indications, Technique, Education, and Decannulation

Fuller

Wineland

Richter

2021

Curr Otorhinolaryngol Rep

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Purpose of Review Tracheostomy in a child demands critical pre-operative evaluation, deliberate family education, competent surgical technique, and multidisciplinary post-operative care. The goals of pediatric tracheostomy are to establish a safe airway, optimize ventilation, and expedite discharge. Herein we provide an update regarding timing, surgical technique, complications, and decannulation, focusing on a longitudinal approach to pediatric tracheostomy care. Recent Findings Pediatric tracheostomy is performed in approximately 0.2% of inpatient stays among tertiary pediatric hospitals. Mortality in children with tracheostomies ranges from 10–20% due to significant comorbidities in this population. Tracheostomy-specific mortality and complications are now rare. Recent global initiatives have aimed to optimize decision-making, lower surgical costs, reduce the length of intensive care, and eliminate perioperative wound complications. The safest road to tracheostomy decannulation in children remains to be both patient and provider dependent. Summary Recent literature provides guidance on safe, uncomplicated, and long-term tracheostomy care in children. Further research is needed to help standardize decannulation protocols.

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Section: Wound Carementioning

confidence: 98%

Update on Pediatric Tracheostomy: Indications, Technique, Education, and Decannulation

Fuller

Wineland

Richter

2021

Curr Otorhinolaryngol Rep

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“…13 While many surgeons prefer twill ties over Velcro ties to lower this potential risk, our review demonstrates no substantial supporting evidence to justify this. Our review found that accidental decannulation is still possible with twill ties, as demonstrated by the several instances of accidental decannulation in the twill group in the study by Hart et al, 11 and actually occurred more frequently in this group than the Velcro group. In the immediate postoperative period, Velcro ties can be loosened or removed with limited manipulation by the patient and without the provider being aware.…”

Section: Discussionmentioning

confidence: 54%

“…Hart et al published a prospective randomized controlled trial comparing twill ties and Velcro ties in patients <21 years old at a single instution. 11 Patients were excluded if they underwent emergent tracheotomy or had a preexisting skin condition (epidermolysis bullosa or genetic skin disorder), and 57 patients were included (twill, n = 30; Velcro, n = 27). Mepilex lite dressings were used in all patients.…”

Section: Resultsmentioning

confidence: 99%

“…A score is given out of 24, with 24 indicating the lowest risk of bias. The MINORS score was 18 for the study by Bitners et al 10 and 17 for Lippert et al 5 The sole randomized study by Hart et al 11 was assessed and determined to be at overall moderate risk of bias based on the Cochrane Risk of Bias Tool.…”

Section: Resultsmentioning

confidence: 99%

“…In the immediate postoperative period, Velcro ties can be loosened or removed with limited manipulation by the patient and without the provider being aware. Two included studies 5 , 11 used a permanent suture to reinforce the Velcro ties at the adjustable points. These were then cut at the time of tracheostomy change.…”

Section: Discussionmentioning

confidence: 99%

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Velcro Ties in Early Postoperative Pediatric Tracheostomy Care: A Systematic Review and Meta‐analysis

Chang

Gurberg

Ware

et al. 2020

Otolaryngol.--head neck surg.

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Objective To systematically review the literature to determine the difference in complications between standard twill and Velcro ties following pediatric tracheostomy. Data Sources MEDLINE, Embase, the Cochrane Database of Systematic Reviews, the Cochrane Central Register of Controlled Trials, Web of Science, and CINAHL Plus were searched up to August 2020. Review Methods Two authors independently screened articles for eligibility. Retrospective and prospective studies were included as long as there was a direct comparison between twill and Velcro ties. Quantitative and qualitative analysis was performed. The main outcomes were skin-related complications and accidental decannulation. Results Three studies were included in the final analysis: 1 randomized prospective trial and 2 retrospective studies. There were 238 patients total (137 twill, 101 Velcro). Combined analysis showed skin-related complications in 23% of the Velcro group and 44% of the twill group. Meta-analysis for skin-related complications showed no significant difference when comparing Velcro with standard twill ties (risk ratio, 0.53 [95% CI, 0.24-1.17]; P = .12, n = 238 participants from 3 studies, I2 = 66%). Accidental decannulation rates were overall low and comparable between groups (1.0% of twill, 1.4% of Velcro). Conclusion Based on limited data, skin-related complications were not statistically different between Velcro and twill ties. Accidental decannulation is rare with Velcro and standard twill ties, and both are viable options following pediatric tracheostomy.

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Race and Ethnicity of Infants Enrolled in Neonatal Clinical Trials

Lyle,

Shaikh,

Oslin

et al. 2023

JAMA Netw Open

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ImportanceRepresentativeness of populations within neonatal clinical trials is crucial to moving the field forward. Although racial and ethnic disparities in research inclusion are well documented in other fields, they are poorly described within neonatology.ObjectiveTo describe the race and ethnicity of infants included in a sample of recent US neonatal clinical trials and the variability in this reporting.Evidence ReviewA systematic search of US neonatal clinical trials entered into Cochrane CENTRAL 2017 to 2021 was conducted. Two individuals performed inclusion determination, data extraction, and quality assessment independently with discrepancies adjudicated by consensus.FindingsOf 120 studies with 14 479 participants that met the inclusion criteria, 75 (62.5%) included any participant race or ethnicity data. In the studies that reported race and ethnicity, the median (IQR) percentage of participants of each background were 0% (0%-1%) Asian, 26% (9%-42%) Black, 3% (0%-12%) Hispanic, 0% (0%-0%) Indigenous (eg, Alaska Native, American Indian, and Native Hawaiian), 0% (0%-0%) multiple races, 57% (30%-68%) White, and 7% (1%-21%) other race or ethnicity. Asian, Black, Hispanic, and Indigenous participants were underrepresented, while White participants were overrepresented compared with a reference sample of the US clinical neonatal intensive care unit (NICU) population from the Vermont Oxford Network. Many participants were labeled as other race or ethnicity without adequate description. There was substantial variability in terms and methods of reporting race and ethnicity data. Geographic representation was heavily skewed toward the Northeast, with nearly one-quarter of states unrepresented.Conclusions and RelevanceThese findings suggest that neonatal research may perpetuate inequities by underrepresenting Asian, Black, Hispanic, and Indigenous neonates in clinical trials. Studies varied in documentation of race and ethnicity, and there was regional variation in the sites included. Based on these findings, funders and clinical trialists are advised to consider a 3-point targeted approach to address these issues: prioritize identifying ways to increase diversity in neonatal clinical trial participation, agree on a standardized method to report race and ethnicity among neonatal clinical trial participants, and prioritize the inclusion of participants from all regions of the US in neonatal clinical trials.

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A randomized controlled trial of Velcro versus standard twill ties following pediatric tracheotomy

Abstract: 1b Laryngoscope, 127:1996-2001, 2017.

Cited by 18 publications

References 17 publications

Update on Pediatric Tracheostomy: Indications, Technique, Education, and Decannulation

Update on Pediatric Tracheostomy: Indications, Technique, Education, and Decannulation

Velcro Ties in Early Postoperative Pediatric Tracheostomy Care: A Systematic Review and Meta‐analysis

Race and Ethnicity of Infants Enrolled in Neonatal Clinical Trials

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