The impact of a tracheostomy-safe bronchoscopy protocol on pediatric tracheostomy outcomes

A Tracheostomy-Safe Bronchoscopy Protocol was developed at our institution in 2019, which aimed to identify and treat upper airway pathologies early and establish emergency airway plans. The objective of this study was to assess the impact of this protocol on tracheostomy-related complications and outcomes.

A retrospective chart review of pediatric patients who underwent tracheostomy between 2015 and 2022 at our institution's two tertiary children's hospitals was conducted. Demographic, operative, and clinical data were collected. Univariate and multivariable analyses were used to assess impact on outcomes, including need for event-initiated intervention, tracheostomy-related complications in the year after surgery, and time to decannulation.

A total of 106 patients were included, of which 62 % underwent tracheostomy after implementation of the protocol. The average age at tracheostomy was 42 months. Of the 42 patients who underwent their first rigid bronchoscopy within 8 weeks, 64 % had at least one intervention, most commonly granulation tissue removal (40 %). Average time to first rigid bronchoscopy was significantly decreased after the protocol compared to before (mean 2.76 vs. 6.61 months, p = 0.01). The post-implementation cohort had significant decreases in the number of first bronchoscopies being adverse-event-induced (36.36 % vs 14.29 %, p = 0.02), in respiratory-related admissions in the year after surgery (mean 0.35 vs 1.61, p = 0.002), and in the average time to decannulation (46.0 months vs 10.45 months, p = 0.012) compared to the pre-implementation cohort.

Pediatric patients with tracheostomies are at risk of developing upper airway pathologies. Implementation of a Tracheostomy-Safe Bronchoscopy Protocol may allow for early identification of potential complications.