Tracheostomy in children with congenital heart disease: a national analysis of the Kids’ Inpatient Database

Abstract

Background. While single-institution studies reported the indications and outcomes of tracheostomy in children with congenital heart disease (CHD), no national analyses have been performed. We sought to examine the indications, performance, outcomes, and resource utilization of tracheostomy in children with CHD using a nationally representative database.Methods. We identified all children undergoing tracheostomy in the Kids’ Inpatient Database 1997 through 2009, and we compared children with CHD to children without CHD. Within the CHD group, we compared children whose tracheostomy occurred in the same hospital admission as a cardiac operation to those whose tracheostomy occurred without a cardiac operation in the same admission.Results. Tracheostomy was performed in n = 2,495 children with CHD, which represents 9.6% of all tracheostomies performed in children (n = 25,928), and 3.5% of all admissions for children with CHD (n = 355,460). Over the study period, there was an increasing trend in the proportion of all tracheostomies that were done in children with CHD (p < 0.0001) and an increasing trend in the proportion of admissions for children with CHD that involved a tracheostomy (p < 0.0001). The population of children with CHD undergoing tracheostomy differed markedly in baseline characteristics, outcomes, and resource utilization. Similarly, the subgroup of children whose tracheostomy was performed in the same admission as a cardiac operation differed significantly from those whose tracheostomy was not.Conclusions. Tracheostomy is an increasingly common procedure in children with CHD despite being associated with significantly greater resource utilization and in-hospital mortality. The population of children with CHD who undergo tracheostomy differs markedly from that of children without CHD who undergo tracheostomy, and important differences are observed between children who undergo tracheostomy in the same admission as a cardiac surgical procedure and those who undergo tracheostomy in a nonsurgical admission, as well as between children with single-ventricle physiology and children with two-ventricle physiology.

Tracheostomy in Infants With Congenital Heart Disease: A Nationwide Population-Based Study in Taiwan

“…21 In this study, the rate was 0.4% among infants with CHD. Compared with our study, previous reports tended to focus on broader pediatric populations or were hospital-based, single-institution investigations with limited numbers of participants.…”

“…The reported incidence of tracheostomy in children with CHD is low in the literature, 17,18,21 with a rate of 0.2% among pediatric subjects undergoing cardiovascular surgery 17 and 3.5% among pediatric admissions with CHD. 21 In this study, the rate was 0.4% among infants with CHD.…”

“…6,[8][9][10][11][12] However, most studies have focused on the indications for tracheostomy, the subsequent outcomes, or resource utilization. 6,[10][11][12][13][14][15][16][17][18][19][20][21][22] Data are scant regarding the epidemiological risk factors for tracheostomy in CHD, and there have been no large-scale population-based studies. Furthermore, among infants with CHD requiring a tracheostomy, previous studies have failed to investigate either the overall mortality risk or the mortality risk stratified by a follow-up period.…”

Assessment of Ovarian Integrity, Reproductive Hormones, and Oxidative Stress in Albino Rats Exposed to Tartrazine Azo Dye

“…Tartrazine toxicity is said to result from the invivo metabolism of its azo bonds which occurs in the liver and the intestine, thereby leading to production of toxic oxidative metabolites such as aryl amines, reactive amines, and free radicals [8,9]. Also, tartrazine dye have been found to covalently react with and destroy the protein active site and configuration of enzymes resulting in loss of normal functioning to the enzyme which may lead to several metabolic consequences [8,9]. Excess in-take of tartrazine dye has been reported to cause attention deficit disorders, allergic and intolerance reactions such as itching, migraines, sleep disturbance, anxiety, blurred vision, and general weakness in children [7,9].…”

Critical Care for Rare Diseases (and Procedures)

“…Specifically, you wonder whether recommending a tracheostomy soon, or after another few weeks of recovery, would benefit the child. The question is being asked with increasing frequency at children's bedsides in both general and cardiac ICUs (2).…”