Pediatric Tracheostomy Outcomes After Development of a Multidisciplinary Airway Team: A Quality Improvement Initiative

Chorney, Stephen R.; Brown, Ashley F; Brooks, Rebecca; Bailey, Candace; Whitney, Cindy; Sewell, Ashley; Johnson, Romaine F.

doi:10.1177/2473974x211045615

Cited by 15 publications

(28 citation statements)

References 28 publications

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“…[22][23][24] Many of these techniques have been employed at this institution with encouraging outcomes. 25 Although lower weight at tracheostomy has not been related to differences in 30-day mortality, 26 the length of follow-up in this series approaches 2 years, which may lend to this finding. Further investigation on the role of weight at tracheostomy will be required.…”

Section: Discussionmentioning

confidence: 63%

“…This population is particularly vulnerable and benefits from standardized protocols for tracheostomy care, which has proven to be beneficial in reducing tracheostomy‐related morbidity 22–24 . Many of these techniques have been employed at this institution with encouraging outcomes 25 . Although lower weight at tracheostomy has not been related to differences in 30‐day mortality, 26 the length of follow‐up in this series approaches 2 years, which may lend to this finding.…”

Section: Discussionmentioning

confidence: 73%

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Mortality Among Children with a Tracheostomy

et al. 2022

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Objectives To characterize the cause of death among children with a tracheostomy. Study Design Prospective cohort. Methods All pediatric patients (<18 years) who had a tracheostomy placed at a tertiary care institution between 2015 and 2020 were included. The location and cause of death were recorded along with patient demographics and age. Results A total of 271 tracheostomies were placed with 46 mortalities reviewed for a mortality rate of 16.8%. Mean age at placement was 1.7 years (SD: 3.4) and mean age at death was 2.9 years (SD: 3.5). Most tracheostomies were placed for respiratory failure (N = 33, 72%). The mean time to death after tracheostomy was 1.2 years (SD: 1.2) and 28% (N = 13) occurred during the same admission as placement. Mean time to death after hospital discharge was 1.3 years (SD: 1.3). Etiology of death was respiratory failure (33%, N = 15), cardiopulmonary arrest (15%, N = 7), unknown (43%, N = 20), or secondary to a tracheostomy‐related complication for 9% (N = 4). Location of death was in intensive care units for 41% (N = 19) and 30% died at home (N = 14). Comfort care measures were taken for 37% (N = 17). Severe neurological disability (HR: 4.06, p = 0.003, 95% CI: 1.59–10.34) and congenital heart disease (HR: 2.36, p = 0.009, 95% CI: 1.24–4.48) correlated with time to death on Cox proportional hazard modeling. Conclusions Nearly one‐third of children with a tracheostomy who expire will do so during the same admission as tracheostomy placement. Although progression of underlying disease will lead to most deaths, 9% will be a result of a tracheostomy‐related complication, which represents a meaningful target for quality improvement initiatives. Level of Evidence 3 Laryngoscope, 133:403–409, 2023

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Section: Discussionmentioning

confidence: 63%

Section: Discussionmentioning

confidence: 73%

Mortality Among Children with a Tracheostomy

et al. 2022

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“…A multidisciplinary team of providers implemented several operational and clinical measures that have been recently described to improve outcomes for tracheostomy-dependent children. 23…”

Section: Discussionmentioning

confidence: 99%

“…CHAMP was developed to address the many recognized poor outcomes among this vulnerable population of children. A multidisciplinary team of providers implemented several operational and clinical measures that have been recently described to improve outcomes for tracheostomy‐dependent children 23 …”

Section: Discussionmentioning

confidence: 99%

“…A multidisciplinary team of providers implemented several operational and clinical measures that have been recently described to improve outcomes for tracheostomy-dependent children. 23 Communication issues have been a focus in prior otolaryngology studies assessing non-English patients. For example, poor communication with non-English-speaking patients has resulted in increased emergency department visits after adenotonsillectomy.…”

Section: Discussionmentioning

confidence: 99%

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Impact of Language and Ethnicity on Pediatric Tracheostomy Outcomes

Garza

Chorney

Kou

et al. 2022

Otolaryngol.--head neck surg.

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Objective To compare outcomes after tracheostomy between children from Spanish- and English-speaking families. Study Design Prospective cohort study. Setting Tertiary care children’s hospital. Methods All children <18 years of age who had a tracheostomy placed between 2014 and 2020 were included. Comorbidities and postsurgical outcomes were compared between (1) children whose families preferred speaking Spanish or identified as Hispanic/Latino and (2) children from English-language or non-Hispanic families. Results A total of 339 children met inclusion, with 11% (37/339) from families identifying Spanish as their primary language and 33% (112/339) identifying as Hispanic. Spanish-speaking families were more likely to have tracheostomy-dependent children with cardiac conditions (65% vs 42%, P = .008) and high complexity (72% vs 49%, P = .007). Outcomes were similar regardless of language preference, with 45% (153/339) still tracheostomy dependent, 28% (94/339) decannulated, and 6.8% (23/339) deceased at a median follow-up of 1.77 years (interquartile range, 0.65-3.43). Severe neurocognitive disabilities were similar between Spanish- and English-language families ( P > .05). Spanish language was not associated with times to decannulation or death in univariate or multiple regression models. A sensitivity analysis of self-identified Hispanic or Latino patients did not show significant differences for time to decannulation, death, or neurocognitive disability rates ( P > .05). Conclusion Spanish language and Hispanic ethnicity appear to have minimal impact on pediatric tracheostomy outcomes.

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Accidental Tracheostomy Decannulations in Children—A Prospective Cohort Study of Inpatients

et al. 2022

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Objectives: To determine the incidence of tracheostomy accidental decannulations (AD) among pediatric inpatients and identify risks for these events.Study Design: Prospective cohort. Methods: All tracheostomy patients (≤18 years) admitted at a tertiary children's hospital between August 2018 and April 2021 were included. AD were recorded and patient harm was classified as no harm/minor, moderate, or severe. Monthly AD incidence was described as events per 1000 tracheostomy-days.Results: One-hundred seventeen AD occurred among 67 children with 33% (22/67) experiencing multiple events (median: 2.5 events, range: 2-10). Mean age at AD was 4.7 years (SD: 4.4). AD resulted from patient movement (32%, 37/117), performing tracheostomy care (27%, 31/117), repositioning or transporting (15%, 17/117), or unclear reasons (27%, 32/117). A parent or guardian was involved in 28% (33/117) of events. Nearly all AD resulted in no more than minor harm (84%, 98/117) but moderate (12%, 14/117) and severe (4%, 5/117) events did occur. There were no deaths. Tracheostomy care or repositioning were frequently responsible in acute versus subacute events (48% vs. 26%, p = 0.04). Mean monthly AD incidence was 4.7 events per 1000 tracheostomy-days (95% CI: 3.7-5.8) and after implementation of safety initiatives, the mean rate decreased from 5.9 events (95% CI: 4.2-7.7) to 3.7 events (95% CI: 2.5-5.0) per 1000 tracheostomy-days (p = 0.04).Conclusions: AD in children occur at nearly 5 events per 1000 tracheostomy-days and often result in minimal harm. Quality initiatives targeting patient movement, provider education, and tracheostomy care might reduce the frequency of these complications.

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Pediatric Tracheostomy Outcomes After Development of a Multidisciplinary Airway Team: A Quality Improvement Initiative

Cited by 15 publications

References 28 publications

Mortality Among Children with a Tracheostomy

Mortality Among Children with a Tracheostomy

Impact of Language and Ethnicity on Pediatric Tracheostomy Outcomes

Accidental Tracheostomy Decannulations in Children—A Prospective Cohort Study of Inpatients

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