Tracheostomy in children with emphasis on home care
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B W Duncan1, L J Howell, A A deLorimier
1Department of Pediatric Surgery, University of California, San Francisco 94143.
Insights
Extensive parental education and home nursing significantly reduce tracheostomy-related deaths in children. This study found no tracheostomy-related deaths in children receiving comprehensive home care and training.
Area of Science:
- Pediatric Surgery
- Respiratory Medicine
- Healthcare Management
Background:
- Tracheostomy in children carries significant mortality risks, particularly after hospital discharge.
- Previous reports indicate high tracheostomy-related mortality rates, ranging from 10% to 27% in hospitalized children.
- Post-discharge mortality rates for children with tracheostomies are estimated at 0.5 to 2 deaths per 100 months at home.
Purpose of the Study:
- To evaluate the impact of intensive parental education and home nursing care on tracheostomy-related mortality in pediatric patients.
- To assess the safety and efficacy of a comprehensive home care regimen for children with tracheostomies.
Main Methods:
- A 9-year retrospective study of 44 children with tracheostomies, averaging 19 months of home care per child.
- Implementation of a tracheostomy care regimen including a minimum of 10 days of intensive parental training before discharge.
- Provision of home nursing care for 77% of children and use of apnea monitors for 83%.
Main Results:
- No tracheostomy-related deaths occurred during hospitalization or after home discharge among the 44 children studied.
- All six deaths observed were attributed to underlying medical conditions, not the tracheostomy itself.
- 34% of the children were successfully decannulated by January 1, 1989.
Conclusions:
- Comprehensive parental education and robust home nursing support are critical for reducing tracheostomy-related mortality in children.
- Effective home management strategies can significantly improve outcomes for pediatric patients with tracheostomies.
- The study demonstrates the feasibility and success of managing children with tracheostomies at home with appropriate support systems.
Abstract:
Tracheostomy in children is not a benign procedure. Tracheostomy-related mortality rates among children have been previously reported to be as high as 10% to 27%. Children with tracheostomies are especially vulnerable after home discharge with mortality rates of 0.5 to 2 deaths per 100 months at home. In order to assess the impact of extensive parental education and home nursing care on tracheostomy-related mortality, we report our experience over 9 years with 44 children receiving tracheostomies. Each child was maintained at home with a tracheostomy for an average of 19 months for a total of 635 months of home tracheostomy care. Indications for tracheostomy were tracheomalacia (32%), obstructive airway lesions (23%), central nervous system lesions (16%), vocal cord paralysis (9%), Pierre Robin syndrome (9%), and a list of miscellaneous conditions (11%). Our tracheostomy care regimen begins with intensive parental training in tracheostomy management for a minimum of 10 days prior to discharge. Home nursing was arranged for 77% of these children for an average of 11 hours per day at the time of discharge. Eighty-three percent had home apnea monitors. Discharge of these children was delayed or transfer to a secondary hospital was made when parents failed to show adequate proficiency in tracheostomy management with existing home nursing. Eight percent were ventilator dependent at discharge. As of January 1, 1989, 34% of these children have been decannulated. There were six deaths, all due to underlying disease. There were no tracheostomy-related deaths in hospital or after discharge home.(ABSTRACT TRUNCATED AT 250 WORDS)