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Published on: January 17, 2011
Routine airway surveillance in pediatric tracheostomy patients
Ozgul Gergin1, Eelam Adil2, Kosuke Kawai3
1Department of Otolaryngology and Communication Enhancement, Boston Children's Hospital, Boston, MA, USA.
Insights
Routine airway evaluation via direct laryngoscopy and bronchoscopy (DLB) is valuable for children with tracheostomies, identifying lesions in over half of patients. Close monitoring is recommended for symptomatic children or those with specific indications for tracheostomy.
Area of Science:
- Pediatric Otolaryngology
- Respiratory Medicine
- Pediatric Surgery
Background:
- Tracheostomy is a common procedure in pediatric care.
- Airway complications can arise post-tracheostomy.
- Surveillance endoscopy is often employed to monitor these patients.
Purpose of the Study:
- To evaluate the diagnostic yield of routine airway endoscopy in children with tracheostomies.
- To determine the incidence and types of airway lesions found.
- To identify patient factors associated with a higher likelihood of airway lesions.
Main Methods:
- Retrospective chart review of pediatric patients who underwent tracheostomy and subsequent direct laryngoscopy and bronchoscopy (DLB).
- Data collected from 1984 to 2015 at a tertiary referral children's hospital.
- Analysis of patient demographics, indications for tracheostomy, time to endoscopy, and identified airway lesions.
Main Results:
- 55.1% of 303 pediatric patients with tracheostomies were diagnosed with airway lesions.
- Suprastomal granulation was the most frequent lesion (39.9%).
- Symptomatic patients (69.9%), ventilator-dependent patients, and those with cardiopulmonary disease or trauma as indications for tracheostomy had a significantly higher incidence of airway lesions.
Conclusions:
- Routine surveillance direct laryngoscopy and bronchoscopy (DLB) is beneficial in pediatric tracheostomy patients due to the high incidence of airway lesions.
- Symptomatic patients and those with specific tracheostomy indications require close monitoring.
- Further research is needed to establish optimal surveillance endoscopy intervals.
Objectives:
The aim of this study is to review airway findings in children with tracheostomies who underwent surveillance direct laryngoscopy and bronchoscopy (DLB) to determine the yield of routine airway evaluation in these patients.
Study Design:
Retrospective chart review at tertiary referral children's hospital.
Methods:
A retrospective chart review was conducted of all of the children with tracheostomies who underwent DLB after tracheostomy between 1984 and 2015.
Results:
A total of 303 patients met inclusion criteria. The median time interval between tracheostomy and first follow-up DLB was 12.0 months (IQR 4.8-28.9 months). There was no significant difference in the incidence of airway lesions between patients who underwent endoscopy <6 months post tracheostomy versus those who had a longer time interval between tracheostomy and DLB (p = 0.16). One hundred sixty seven patients (55.1%) were diagnosed with lesions, with suprastomal granulation (39.9%) being the most common. Symptomatic patients were significantly more likely to have an airway lesion identified (69.9% versus 42.0%; p < 0.001). Ventilator dependent patients and those with either cardiopulmonary disease or traumatic injury as indications for tracheostomy were significantly more likely to have an airway lesion (p = 0.01).
Conclusions:
The high incidence of airway lesions noted during surveillance DLB support the utility of routine airway endoscopy in pediatric tracheostomy patients. Symptomatic patients, those with ventilator dependence, or cardiopulmonary or trauma indications for tracheostomy are more likely to have airway lesions and should be monitored closely. The ideal time interval between surveillance endoscopies needs to be examined further.
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