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Indications and Outcomes for Tracheostomies in Pediatric Oncology Patients-A Single Center Study
Jonathan Pan1, Bryony Lucas1,2, M Fatih Okcu1,2
1Department of Pediatrics, Texas Children's Hospital, Baylor College of Medicine, Houston, Texas, USA.
Insights
Pediatric cancer patients requiring tracheostomies experienced outcomes similar to the general pediatric population. This study provides key data on indications, complications, and decannulation rates for this vulnerable group.
Area of Science:
- Pediatric Oncology
- Critical Care Medicine
- Otolaryngology
Background:
- Children with cancer often require prolonged mechanical ventilation, necessitating tracheostomies.
- Literature on tracheostomy outcomes specifically for pediatric cancer patients is limited.
- Tracheostomies, while generally safe, carry rare but significant risks.
Purpose of the Study:
- To characterize pediatric cancer patients who underwent tracheostomy.
- To describe indications for tracheostomy in this population.
- To report outcomes including length of stay, decannulation, and complications.
Main Methods:
- Retrospective analysis of medical records.
- Inclusion of all pediatric patients with cancer who received tracheostomies.
- Study conducted at a single, high-volume children's hospital from 2004-2023.
Main Results:
- Sixty-five patients were identified with a median follow-up of 763 days.
- Indications included tumor mass effect (32%), cancer treatment complications (25%), non-oncologic reasons (22%), and perioperative management (22%).
- Decannulation occurred in 45% of patients; 26% experienced complications (e.g., tracheitis, tracheocutaneous fistula), with no tracheostomy-associated mortality.
Conclusions:
- Tracheostomy complication rates and decannulation in pediatric cancer patients are comparable to the general pediatric population.
- This study provides essential reference data for clinicians managing pediatric cancer patients requiring tracheostomies.
- Findings aid in setting expectations for outcomes and managing potential complications.
Background:
Children with cancer face a high risk of complications including prolonged mechanical ventilation requiring tracheostomies. While tracheostomies have been demonstrated to be a generally safe procedure, there remain significant rare complications and a paucity of literature addressing outcomes specifically for pediatric patients with cancer. The objective of this study was to characterize pediatric patients with cancer who underwent tracheostomies and describe their indications and outcomes for length of stay, decannulation, and complications.
Procedures:
At a single large volume children's hospital, retrospective medical record analysis was performed in all pediatric patients with cancer who received tracheostomies from 2004 to 2023.
Results:
Sixty-five patients were identified with a median follow-up time of 763 days (interquartile range 302-1687). Twenty-one (32%) patients had a tracheostomy placed due to complications from mass effect of the tumor, 16 (25%) due to complications from cancer treatment, and 14 (22%) had a tracheostomy placed for nononcologic reasons. Additionally, a distinct subgroup of 14 (22%) patients underwent tracheostomy perioperatively for elective airway management during surgical resection of their tumors. Twenty-nine (45%) were decannulated and 17 (26%) patients had a tracheostomy-associated complication, including tracheitis and tracheocutaneous fistula, and no patients had a tracheostomy-associated mortality.
Conclusions:
The incidence of tracheostomy-associated complications and decannulation rates in pediatric patients with cancer was comparable with the general pediatric tracheostomy population. This study establishes a reference point for clinicians regarding the anticipated outcomes among pediatric patients with cancer requiring or having undergone a tracheostomy.
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