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

Fuller, Colin W; Wineland, Andre; Richter, Gresham T.

doi:10.1007/s40136-021-00340-y

Cited by 34 publications

(31 citation statements)

References 66 publications

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“…Tracheostomy-related complications are more common in children than in adults, due to characteristics of the airway and the degree of medical complexity in children requiring tracheostomies. [25][26][27] Tracheostomy-associated emergencies can occur at any time after placement. Most of these complications including obstruction of the tracheostomy cannula, wound problems and accidental decannulation may cause life-threatening problems and could be reduced by improving TC.…”

Section: Resultsmentioning

confidence: 99%

Efficacy of standardized tracheostomy training with a simulation model for healthcare providers: A study by ISPAT team

Uyan

Atağ

Ergenekon

et al. 2021

Pediatric Pulmonology

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Introduction: Tracheostomy care in children may be challenging, due to lack of knowledge of healthcare providers (HCPs). The aim of this study was to determine the level of knowledge of HCP who follow patients with tracheostomy and to increase this level with theoretical training and training in a simulation laboratory. Materials and Methods: ISPAT (IStanbul PAediatric Tracheostomy), a multidisciplinary team for tracheostomy care was established and a training program was prepared. Participants were subjected to theoretical and practical pretests which evaluated their knowledge levels and skills for care, follow-up, and treatment of a patient with tracheostomy. After the theoretical and practical training given to the participants with a simulation model, theoretical and practical posttests were applied. Results: Fifty-one HCP from nine tertiary pediatric clinics in Istanbul were enrolled in the training program. Only six (11.8%) of them had received standardized training programs previously. Regarding the theoretical tests, seven of the 33 questions were indicated as essential. The knowledge level of the participants based on the essential questions significantly increased after the training (p < 0.05 for all of the essential questions). The total number of correct answers and correct answers of three subheadings also significantly increased after the practical training (p < 0.001 for all).Ninety-five percent of the participants assessed the course as good or excellent in general.

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Section: Resultsmentioning

confidence: 99%

Efficacy of standardized tracheostomy training with a simulation model for healthcare providers: A study by ISPAT team

Uyan

Atağ

Ergenekon

et al. 2021

Pediatric Pulmonology

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“…However, the surgery for moderate and severe OSA by UPPP base therapy produced a limited successful outcome. The BMI, AHI severity, age of patient, pattern of airway collapse, experience of the surgeon, and even the patient’s choice all affect the treatment outcome [ 31 ]. In addition, the tongue base is addressed more by sleep physicians in moderate and severe OSA patients in the practice of drug-induced sleep endoscopy.…”

Section: Discussionmentioning

confidence: 99%

Combined Transoral Robotic Tongue Base Surgery and Palate Surgery in Obstructive Sleep Apnea Syndrome: Modified Uvulopalatopharyngoplasty versus Barbed Reposition Pharyngoplasty

Tsou

Hsu

Shih

et al. 2021

JCM

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Background: Successful surgery outcomes are limited to moderate to severe obstructive sleep apnea (OSA) syndrome. Multilevel collapse at retropalatal and retroglossal areas is often found during the drug-induced sleep endoscopy (DISE). Therefore, multilevel surgery is considered for these patients. The aim of our study was to survey surgical outcomes by modified uvulopalatoplasty (UPPP) plus transoral robotic surgery tongue base reduction (TORSTBR) versus barbed repositioning pharyngoplasty (BRP) plus TORSTBR. Methods: The retrospective cohort study was performed at a tertiary referral center. We collected moderate to severe OSA patients who were not tolerant to positive pressure assistant PAP from September 2016 to September 2019; pre-operative–operative Muller tests all showed retropalatal and retroglossal collapse; pre-operative Friedman Tongue Position (FTP) > III, with the tonsils grade at grade II minimum, with simultaneous velum (V > 1) and tongue base (T > 1), collapsed by drug-induced sleep endoscopy (DISE) under the VOTE grading system. The UPPP plus TORSTBR (n = 31) and BRP plus TORSTBR (n = 31) techniques were offered. We compare the outcomes using an Epworth sleepiness scale (ESS) questionnaire, and measure the patients’ apnea–hypopnea index (AHI), lowest O2 saturation, cumulative time spent below 90% (CT90), and arousal index (AI) by polysomnography six months after surgery; we also measure their length of hospital stay and complications between these two groups. Results: Comparing BRP plus TORSTBR with UPPP plus TORSTBR, the surgical success rate is 67.74% and 38.71%, respectively. The significantly higher surgical success rate in the BRP plus TORSTBR group was noted. The surgical time is shorter in the BRP plus TORSTBR group. The complication rate is not significant in pain, bleeding, dysgeusia, dysphagia, globus sensation, and prolonged suture stay, even though the BRP plus TORSTBR rendered a higher percentage of globus sensation during swallowing and a more prevalent requirement of suture removal one month after surgery. The length of hospital stay is not significantly different between the two groups. Conclusion: In conclusion, BRP plus TORSTBR is a considerable therapy for moderate to severe OSA patients with DISE showing a multi-level collapse in velum and tongue base area. The BRP technique might offer a better anterior–posterior suspension vector for palate level obstruction.

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“…Adults have higher rates of decannulation, with many adults decannulated prior to discharge from the hospitalization during which they received a tracheostomy. Given that pediatric patients who most often undergo tracheostomy are medically complex, the rate of successful decannulation is much lower when compared with that of adults (7). The decannulation process in pediatric patients is also more complicated compared with adults due to their small airway size and developmental limitations.…”

Section: What This Study Meansmentioning

confidence: 99%

Timing of Tracheostomy in Critically Ill Infants and Children With Respiratory Failure: A Pediatric Health Information System Study

Mehrotra

Thomas

Gerber

et al. 2023

Pediatric Critical Care Medicine

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OBJECTIVES:Tracheostomy placement in infants and children with respiratory failure has steadily increased over time, yet there is no consensus for optimal timing. We sought to: 1) describe tracheostomy timing and associated demographic and clinical characteristics in a large ICU cohort and 2) compare clinical outcomes between subgroups based on tracheostomy timing. DESIGN:Retrospective observational study using the Pediatric Health Information System (PHIS). SETTING: Neonatal ICUs and PICUs in the United States.PATIENTS: PHIS was queried for patients less than 18 years who underwent tracheostomy from 2010 to 2020. Patients were included if admitted to an ICU with need for mechanical ventilation (MV) prior to tracheostomy in the same hospitalization. Patients were categorized as early tracheostomy (ET) (placement at MV day ≤ 14), late tracheostomy (LT) (MV days 15-60), and extended tracheostomy (ExT) (MV day > 60). Primary endpoints included demographic and clinical characteristics. Secondary endpoints included patient outcomes: in-hospital mortality, length of stay (LOS), hospital-acquired pneumonia (HAP), and hospital costs. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS:Sixteen thousand one hundred twenty-one patients underwent tracheostomy at 52 children's hospitals. Ten thousand two hundred ninety-five had complete data and were included in the analysis. Thirty-nine percent (4,006/10,295) underwent ET, 40% (4,159/10,295) underwent LT, and 21% (2,130/10,295) underwent ExT. Majority of patients in all subgroups had complex chronic conditions. Median age was significantly different between subgroups with ET being the oldest (p < 0.001). A multivariable regression analysis showed that ET was associated with lower in-hospital mortality (p < 0.001), shorter hospital LOS (p < 0.001), shorter ICU LOS (p < 0.001), shorter post-tracheostomy LOS (p < 0.001), decreased HAP (p < 0.001), and lower hospital costs (p < 0.001) compared with those who underwent LT or ExT. CONCLUSIONS:In a large cohort of pediatric patients with respiratory failure, tracheostomy placement within 14 days of MV was associated with improved inhospital outcomes. ET was independently associated with decreased mortality, LOS, HAP, and hospital costs.

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

Cited by 34 publications

References 66 publications

Efficacy of standardized tracheostomy training with a simulation model for healthcare providers: A study by ISPAT team

Efficacy of standardized tracheostomy training with a simulation model for healthcare providers: A study by ISPAT team

Combined Transoral Robotic Tongue Base Surgery and Palate Surgery in Obstructive Sleep Apnea Syndrome: Modified Uvulopalatopharyngoplasty versus Barbed Reposition Pharyngoplasty

Timing of Tracheostomy in Critically Ill Infants and Children With Respiratory Failure: A Pediatric Health Information System Study

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