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Tracheostomy Complications in Institutionalized Children with Long-term Tracheostomy and Ventilator Dependence
Lyndy J Wilcox1, Brittany C Weber2, Tina D Cunningham3
1Department of Otolaryngology-Head and Neck Surgery, Eastern Virginia Medical School, Norfolk, Virginia, USA wilcoxlj@evms.edu lyndyjane8@gmail.com.
Insights
Tracheostomy complications are frequent in institutionalized children with chronic tracheostomy, with 84% experiencing issues like granulation. Factors like age or ventilator dependence did not predict these common complications.
Area of Science:
- Pediatric Otolaryngology
- Pediatric Pulmonology
- Pediatric Critical Care
Background:
- Institutionalized children with chronic tracheostomy often have complex medical needs.
- Tracheostomy is a critical intervention for these children but carries inherent risks.
- Understanding complication patterns is vital for improving patient care.
Purpose of the Study:
- To identify the types and frequency of tracheostomy complications in institutionalized children.
- To determine potential predictive factors for developing these complications.
- To review interventions for tracheostomy-related issues in this population.
Main Methods:
- A 10-year retrospective chart review was conducted at a tertiary children's hospital.
- Included were children under 21 with chronic tracheostomy residing in a pediatric nursing facility.
- Data collected included complication types, unplanned admissions, and interventions.
Main Results:
- Eighty-four percent (27/32) of children experienced at least one tracheostomy complication.
- The most common complications were peristomal and suprastomal granulation.
- Neither age at tracheostomy, duration of institutionalization, nor ventilator dependence predicted complication occurrence.
Conclusions:
- Tracheostomy complications are highly prevalent in institutionalized children with chronic tracheostomy.
- These complications present significant management challenges.
- Further research is needed to develop strategies for reducing complication rates in this vulnerable population.
Objectives:
(1) To identify tracheostomy complications in institutionalized children with chronic tracheostomy. (2) To determine factors that predispose to development of tracheostomy complications in institutionalized children with chronic tracheostomy.
Study Design:
Case series with chart review over 10 years.
Setting:
Tertiary children's hospital.
Subjects And Methods:
Children were included if they underwent tracheostomy before 21 years of age and resided at a pediatric nursing facility. Most children were ventilator dependent and had severe comorbid medical conditions, including developmental delay and cerebral palsy. The number of tracheostomy complications and unplanned hospital admissions were recorded. Interventions for tracheostomy complications were also reviewed.
Results:
Thirty-two institutionalized children with chronic tracheostomy were included. The mean age at time of tracheostomy was 5.4 years, with a mean duration of institutionalization of 9.1 years. Twenty-seven children (84%) experienced tracheostomy complications. The total number of complications was 79. The most common tracheostomy complications identified were peristomal granulation (n = 13) and suprastomal granulation (n = 12). Age at time of tracheostomy, duration of institutionalization, and ventilator dependence did not predict the likelihood of developing a complication. Of 32 patients, 20 were evaluated in the emergency room during the study, and there were 48 unplanned admissions for tracheostomy-related complications during the study. Forty-five urgent direct laryngoscopy and bronchoscopy procedures were performed in a total of 20 children with tracheostomy complications.
Conclusions:
Tracheostomy complications are common in institutionalized children with chronic tracheostomy and are challenging to manage. Further research is necessary to determine novel ways to reduce tracheostomy complications in this population.
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