Practice patterns after tracheotomy in infants younger than 2 years.

Area of Science:

• Pediatric Otolaryngology
• Pediatric Airway Management
• Surgical Outcomes

Background:

• Suprastomal granuloma (SSG) is a common complication in young children with tracheostomy tubes.
• Varied practice patterns exist regarding surveillance endoscopy and SSG management.
• There is a need to understand current practices to improve patient care.

Purpose of the Study:

• To survey members of the American Society of Pediatric Otolaryngology (ASPO) regarding their practice patterns for surveillance endoscopy and SSG management in children under 2 years old with tracheostomy tubes.
• To review internal practice patterns at a tertiary children's hospital.
• To identify areas for potential guideline development.

Main Methods:

• A survey was administered to ASPO members on indications for infant tracheotomy, bronchoscopy, and SSG treatment.
• Retrospective medical chart review of patients under 2 years old who underwent tracheotomy between 1996 and 2006.
• Data collected included demographics, comorbidities, tracheotomy indications, endoscopy frequency, SSG occurrence, and interventions.

Main Results:

• Survey results indicated wide variation in bronchoscopy frequency and SSG management preferences among ASPO members.
• Indications for bronchoscopy included preparation for laryngotracheal reconstruction, decannulation, bleeding, and difficult tube changes.
• In the internal review, 39.4% of patients had SSG at first bronchoscopy; 46.5% underwent removal, with a 45% recurrence rate. Spontaneous resolution occurred in 65% of untreated SSG.
• Practice patterns for endoscopy and SSG management varied significantly within the institution.

Conclusions:

• Significant variability exists in current practice patterns for surveillance endoscopy and SSG management in pediatric tracheostomy patients.
• The development of clinical practice guidelines is recommended to standardize care and potentially reduce unnecessary procedures.
• Further research may help establish evidence-based recommendations for SSG management.