PT  - JOURNAL ARTICLE
AU  - Nickel, Amanda J.
AU  - Miles, Lucy
AU  - Chidambaram, Ambika
AU  - Napolitano, Natalie
TI  - The Landscape of Care for Tracheostomies at a Quaternary Children’s Hospital
DP  - 2021 Oct 01
TA  - Respiratory Care
PG  - 3605916
VI  - 66
IP  - Suppl 10
4099  - http://rc.rcjournal.com/content/66/Suppl_10/3605916.short
4100  - http://rc.rcjournal.com/content/66/Suppl_10/3605916.full
AB  - 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.