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Mortality in the pediatric patient with tracheotomy
J M Dutton1, P M Palmer, T M McCulloch
1University of Iowa Hospitals and Clinics, Department of Otolaryngology, Iowa City 52242-1078, USA.
Insights
Child mortality with tracheotomy is high, but deaths directly caused by the procedure are rare. Factors like mechanical ventilation and lung disease indicate a poorer prognosis for pediatric patients.
Area of Science:
- Pediatric Medicine
- Otolaryngology
- Critical Care
Background:
- Pediatric tracheotomy is associated with significant mortality rates, estimated between 11% and 40%.
- Tracheotomy-related deaths in children are infrequent, occurring in 0% to 3.4% of cases.
Purpose of the Study:
- To analyze the mortality rate in children who have undergone a tracheotomy.
- To identify factors influencing prognosis in pediatric patients with tracheotomies.
Main Methods:
- Retrospective review of medical records for children who underwent tracheotomy at a single institution over a 15-year period (1975-1989).
- Data analyzed in three 5-year blocks to assess trends.
- Comorbidity score (CS) calculated based on airway diagnoses.
Main Results:
- Fifty-two patients died with tracheotomy tubes in situ; only 4 deaths were tracheotomy-related (tube displacement/obstruction or vascular hemorrhage).
- Average age of deceased patients decreased over the study period, with younger patients dying more frequently in later years.
- Higher comorbidity scores and the need for mechanical ventilation or presence of pulmonary disease were associated with poorer outcomes.
Conclusions:
- The presence of a tracheotomy tube itself does not appear to be the primary driver of mortality.
- Mechanical ventilation and pulmonary disease are independent risk factors for poor prognosis in pediatric tracheotomy patients.
- Tracheotomies performed for surgical airway access were associated with a better prognosis.
Background:
The mortality rate of children with tracheotomies is estimated to be between 11% and 40%, although the incidence of tracheotomy-related deaths is only between 0% and 3.4%. The purpose of this report was to analyze the mortality rate in children with tracheotomies.
Methods:
A review of the medical records of children at the University of Iowa Hospitals and Clinics who underwent tracheotomy over a 15-year period ending in 1989 was performed. Data were analyzed in 5-year time blocks (Block 1, 1975 to 1979; Block 2, 1980 to 1984; and Block 3, 1985 to 1989).
Results:
Fifty-two patients died with tracheotomy tubes in place. In 4 patients, the cause of death was tracheotomy related. Three of these patients were under 5 years of age and died secondary to tracheotomy tube displacement or obstruction; one patient, an 18-year-old, developed a fatal tracheotomy-related vascular hemorrhage. The average age of patients who died with tracheotomies decreased significantly from Block 1 to Block 3; in Block 3, mean age at the time of tracheotomy was significantly lower in patients who died than in patients who survived. A comorbidity score (CS) based on the number of airway diagnoses showed that higher CSs were associated with a poorer prognosis.
Conclusions:
Mortality does not seem to be strongly related to the presence of the tracheotomy tube. Overall, two diagnostic groups were found to be independently associated with a poorer prognosis, ie, mechanical ventilation and pulmonary disease. Tracheotomies performed to provide airway access during other surgical procedures were associated with a better prognosis.
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