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A decade of pediatric tracheostomies: Indications, outcomes, and long-term prognosis
Mona L McPherson1, Lara Shekerdemian1, Michelle Goldsworthy1
1Department of Pediatrics, Baylor College of Medicine, Texas Children's Hospital, Section of Critical Care Medicine, Fannin 6621, WT 6-006, Houston 77030, Texas.
Insights
This study on pediatric tracheostomy found that mortality and decannulation rates vary significantly based on the reason for the procedure. Airway obstruction cases had better survival, while acquired neurologic disease indicated higher mortality risks for children.
Area of Science:
- Pediatric critical care medicine
- Respiratory medicine
- Pediatric surgery
Background:
- Tracheostomy is a critical intervention for children with complex respiratory needs.
- Understanding long-term outcomes is essential for optimizing patient care and resource allocation.
Purpose of the Study:
- To define mortality and long-term outcomes in children who underwent tracheostomy.
- To analyze how tracheostomy indications and patient age influence survival and decannulation rates.
Main Methods:
- Retrospective review of 426 pediatric patients who underwent tracheostomy between 2001 and 2011.
- Analysis of mortality and decannulation rates based on tracheostomy indication and age.
- Utilized data from a Pediatric Intensive Care Unit and the Texas Department of Health Bureau of Vital Statistics.
Main Results:
- Overall mortality was 23% (98/426) with a median survival of 5.9 years.
- Patients with airway obstruction had the lowest mortality; those with acquired neurologic disease had the highest.
- Decannulation occurred in 38% (163/426) of patients, with a median time to decannulation of 1.2 years.
- Congenital neurologic disease was associated with the lowest likelihood of decannulation.
- Over half of discharged patients required ongoing mechanical respiratory support.
Conclusions:
- Mortality risk following pediatric tracheostomy is significantly influenced by the underlying indication.
- The likelihood of successful decannulation also correlates strongly with the reason for the tracheostomy.
- Further research is needed to elucidate specific causes of mortality.
Objective:
To define the mortality and long-term outcomes of children undergoing tracheostomy.
Design:
Retrospective chart and Texas Department of Health Bureau of Vital Statistics review of patients admitted to a Pediatric Intensive Care Unit who underwent a tracheostomy between 2001 and 2011. Mortality and decannulation rates were compared based on tracheostomy indication and age.
Subjects:
A total of 426 patients admitted to a Pediatric Intensive Care Unit in a large tertiary children's hospital.
Results:
The median patient age was 1.5 years (3 days-24 years). Primary indications for tracheostomy included (a) airway obstruction, (b) congenital neurologic disease, (c) acquired neurologic disease, (d) congenital respiratory disease, and (e) acquired respiratory disease. Overall, 98 patients (23%) died during the study period, and 75th percentile survival time was 5.9 years (95%CI: 3-8). Patients undergoing a tracheostomy for airway obstruction were the least likely to die; while patients with acquired neurologic disease were most likely to die. A total of 163 patients (38%) were decannulated, and 50% were decannulated at 1.2 years (95%CI: 0.9-1.5). Patients with congenital neurologic disease were the least likely to undergo decannulation. Over half of the patients were discharged from the hospital requiring some form of mechanical respiratory support in addition to their tracheostomy.
Conclusions:
In this largest cohort of long-term follow-up to date, we have shown the overall risk of mortality varied according to the indication for the tracheostomy. We were unable to determine exact causes of death. The likelihood of being decannulated also correlates with the underlying indication for the tracheostomy. Pediatr Pulmonol. 2017; 52:946-953. © 2017 Wiley Periodicals, Inc.
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