Tracheotomy in Pediatric Patients

Abstract

Pediatric tracheotomy is associated with significant variation in rates and outcomes across the United States and across different hospital types. Further research to clarify the reasons for these associations is warranted.

A Multidisciplinary Children’s Airway Center: Impact on the Care of Patients With Tracheostomy

“…14,[18][19][20][21] The initiative to improve communication resulted in implementation of weekly clinical care conferences focused on treatment planning, with video review and discussion of airway pathology contributing an educational component. Efforts to avoid tracheostomy complications led to applying a consensus-driven algorithm to the decannulation process increasing the likelihood of successful decannulation by 18%, and aligning institutional standards with nationally recognized recommendations for interval airway surveillance examinations of 6 to 12 months.…”

The Chronically Critically Ill Patient: Pediatric Considerations

“…It should be noted that tracheostomy placement in the pediatric population is common, with approximately 5,000 procedures annually in the United States. 28 Graf et al 4 found that the most common reasons for tracheostomy placement in the pediatric population are airway management (63%), chronic respiratory disease (23%), central hypoventilation (9%), and neuromuscular weakness (6%). Other general indications include chronic respiratory disease, central hypoventilation syndrome, and neuromuscular weakness in descending order of occurrence.…”

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

“…HR ϭ hazard ratio CHD ϭ congenital heart disease NI ϭ neuromuscular impairment CAA ϭ congenital airway anomaly bation after cardiac surgery, 18,20,29,30 and comorbid chronic health conditions. 6,10 Although the effect was not significant, comorbidity with prematurity seemed to decrease the probability of tracheostomy placement (adjusted OR 0.89, 95% CI 0.58 -1.37), which may be due to the co-linearity between such factors as prematurity and chronic lung disease. Further investigations into the relationships between the severity of CHD, its management, and the effects of different comorbidities by age strata may clarify these uncertainties.…”

“…6,10,14 Reports have also indicated that the mortality rate among pediatric subjects with CHD and a tracheostomy ranges from 18.7% 6 to 52%. 20 In this study, we report a mortality rate of 43.1% for infants with CHD undergoing tracheostomy.…”

“…5,6 Although infections have historically been the most common indication, 7 tracheos-tomies are increasingly indicated for prolonged ventilator dependence in children with chronic complex health conditions. 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.…”