Abstract
Background: The utilization of tracheostomies in pediatric patients for the management of chronic disease has increased in recent years. Little prevalence data exists to describe this population and the adverse events related to tracheostomy care.
Methods: A retrospective observational trial was performed of all inpatient tracheostomy patients between January 1 and June 30, 2020. Patients remaining admitted were followed to discharge or to December 31, 2020, whichever came sooner. Descriptive statistics were conducted to describe trends in prevalence data. The IRB granted an exemption for the study.
Results: A total of 241 tracheostomy patients were admitted, median age 5 y old (IQR 3–11). Number of admissions per patient averaged 1.44, while median length of stay was 7 d (IQR 3–62). Admission diagnoses were grouped as upper and lower respiratory, home medical emergency, sepsis/shock, cardiology, neurology, planned, or other (Table 1). 83.8% were discharged on home respiratory support, with 68.5% requiring positive pressure ventilation. 43.2% patients were discharged on either or both pharmacologic and/or mechanical airway clearance. The majority of patients received routine tracheostomy tube changes on a weekly basis (78.9%), while others received them every 2 weeks or 4 weeks, 11.7% and 8.6% respectively. Adverse events (Table 2) were characterized as skin breakdown (29.3%), granulation tissue (24.1%), tracheitis (4.1%), pneumonia (0.6%), cellulitis (0.6%), tracheostomy site bleeding (3.2%), and emergency tracheostomy change (5.8%). Unplanned decannulations (one event or more per patient) were tracked with an incidence of 10.4%.
Conclusions: Pediatric tracheostomy patients are hospitalized for a broad range of chronic and acute conditions. Skin breakdown and granulation tissue were the most frequent adverse events associated with pediatric tracheostomy, while respiratory infections, cellulitis, bleeding, and need for emergency tracheostomy change were infrequent. Routine tracheostomy tube changes most often occur weekly.
Footnotes
Commercial Relationships: AN has a research relationship with Nihon Kohden. NN has research/consulting relationships with Dräger Medical, Smiths Medical, Philips/Respironics, and VERO-Biotech.
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