Mortality Among Children with a Tracheostomy.
mortality
pediatric tracheostomy
tracheostomy-related complications
Journal
The Laryngoscope
ISSN: 1531-4995
Titre abrégé: Laryngoscope
Pays: United States
ID NLM: 8607378
Informations de publication
Date de publication:
02 2023
02 2023
Historique:
revised:
17
03
2022
received:
01
03
2022
accepted:
21
03
2022
pubmed:
1
4
2022
medline:
19
1
2023
entrez:
31
3
2022
Statut:
ppublish
Résumé
To characterize the cause of death among children with a tracheostomy. Prospective cohort. All pediatric patients (<18 years) who had a tracheostomy placed at a tertiary care institution between 2015 and 2020 were included. The location and cause of death were recorded along with patient demographics and age. A total of 271 tracheostomies were placed with 46 mortalities reviewed for a mortality rate of 16.8%. Mean age at placement was 1.7 years (SD: 3.4) and mean age at death was 2.9 years (SD: 3.5). Most tracheostomies were placed for respiratory failure (N = 33, 72%). The mean time to death after tracheostomy was 1.2 years (SD: 1.2) and 28% (N = 13) occurred during the same admission as placement. Mean time to death after hospital discharge was 1.3 years (SD: 1.3). Etiology of death was respiratory failure (33%, N = 15), cardiopulmonary arrest (15%, N = 7), unknown (43%, N = 20), or secondary to a tracheostomy-related complication for 9% (N = 4). Location of death was in intensive care units for 41% (N = 19) and 30% died at home (N = 14). Comfort care measures were taken for 37% (N = 17). Severe neurological disability (HR: 4.06, p = 0.003, 95% CI: 1.59-10.34) and congenital heart disease (HR: 2.36, p = 0.009, 95% CI: 1.24-4.48) correlated with time to death on Cox proportional hazard modeling. Nearly one-third of children with a tracheostomy who expire will do so during the same admission as tracheostomy placement. Although progression of underlying disease will lead to most deaths, 9% will be a result of a tracheostomy-related complication, which represents a meaningful target for quality improvement initiatives. 3 Laryngoscope, 133:403-409, 2023.
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
403-409Informations de copyright
© 2022 The American Laryngological, Rhinological and Otological Society, Inc.
Références
Shah RK, Stey AM, Jatana KR, Rangel SJ, Boss EF. Identification of opportunities for quality improvement and outcome measurement in pediatric otolaryngology. JAMA Otolaryngol - Head Neck Surg. 2014;140(11):1019-1026.
Brown C, Shah GB, Mitchell RB, Lenes-Voit F, Johnson RF. The incidence of pediatric tracheostomy and its association among black children. Otolaryngol Head Neck Surg. 2020;164:206-211.
Funamura JL, Yuen S, Kawai K, et al. Characterizing mortality in pediatric tracheostomy patients. Laryngoscope. 2017;127(7):1701-1706.
Muller RG, Mamidala MP, Smith SH, Smith A, Sheyn A. Incidence, epidemiology, and outcomes of pediatric tracheostomy in the United States from 2000 to 2012. Otolaryngol Head Neck Surg. 2019;160(2):332-338.
Roberts J, Powell J, Begbie J, et al. Pediatric tracheostomy: a large single-center experience. Laryngoscope. 2020;130(5):E375-E380.
Salley J, Kou YF, Shah GB, Mitchell RB, Johnson RF. Survival analysis and decannulation outcomes of infants with tracheotomies. Laryngoscope. 2020;130(10):2319-2324.
Davidson C, Jacob B, Brown A, et al. Perioperative outcomes after tracheostomy placement among complex pediatric patients. Laryngoscope. 2021;131(8):E2469-E2474. https://doi.org/10.1002/lary.29402.
Mitchell RB, Hussey HM, Setzen G, et al. Clinical consensus statement: tracheostomy care. Otolaryngol Head Neck Surg. 2013;148(1):6-20.
Friesen TL, Zamora SM, Rahmanian R, Bundogji N, Brigger MT. Predictors of pediatric tracheostomy outcomes in the United States. Otolaryngol Head Neck Surg. 2020;163(3):591-599.
Newton M, Johnson RF, Wynings E, Jaffal H, Chorney SR. Pediatric tracheostomy-related complications: a cross-sectional analysis. Otolaryngol Head Neck Surg. 2021;1945998211046527.
Edwards JD, Kun SS, Keens TG. Outcomes and causes of death in children on home mechanical ventilation via tracheostomy: an institutional and literature review. J Pediatr. 2010;157(6):955-959.
Strang AR, Briddell JW, Barth PC, Shah UK, Chidekel A. Risk factor analysis for mortality among infants requiring tracheostomy. Pediatr Pulmonol. 2018;53(8):1115-1121.
Wood W, Wang CS, Mitchell RB, Shah GB, Johnson RF. A longitudinal analysis of outcomes in tracheostomy placement among preterm infants. Laryngoscope. 2021;131(2):417-422.
Johnson RF, Brown A, Brooks R. The family impact of having a child with a tracheostomy. Laryngoscope. 2021;131(4):911-915.
Liao K, Chorney SR, Brown AB, et al. The impact of socioeconomic disadvantage on pediatric tracheostomy outcomes. Laryngoscope. 2021;131(11):2603-2609.
Johnson RF, Brown CM, Beams DR, et al. Racial influences on pediatric tracheostomy outcomes. Laryngoscope. 2021.
von Elm E, Altman DG, Egger M, et al. The strengthening the reporting of observational studies in epidemiology (STROBE) statement: guidelines for reporting observational studies. PLoS Med. 2007;4(10):e296.
Hebbar KB, Kasi AS, Vielkind M, et al. Mortality and outcomes of pediatric tracheostomy dependent patients. Front Pediatr. 2021;9:661512. https://doi.org/10.3389/fped.2021.661512.
Ozmen S, Ozmen OA, Unal OF. Pediatric tracheotomies: a 37-year experience in 282 children. Int J Pediatr Otorhinolaryngol. 2009;73(7):959-961. https://doi.org/10.1016/j.ijporl.2009.03.020.
Mahadevan M, Barber C, Salkeld L, Douglas G, Mills N. Pediatric tracheotomy: 17 year review. Int J Pediatr Otorhinolaryngol. 2007;71(12):1829-1835. https://doi.org/10.1016/j.ijporl.2007.08.007.
Berry JG, Graham RJ, Roberson DW, et al. Patient characteristics associated with in-hospital mortality in children following tracheotomy. Arch Dis Child. 2010;95(9):703-710. https://doi.org/10.1136/adc.2009.180836.
Ong T, Liu CC, Elder L, et al. The trach safe initiative: a quality improvement initiative to reduce mortality among pediatric tracheostomy patients. Otolaryngol Head Neck Surg. 2020;163(2):221-231. https://doi.org/10.1177/0194599820911728.
Tolomeo CT, Major NE, Szondy MV, Bazzy-Asaad A. Standardizing care and parental training to improve training duration, referral frequency, and length of stay: our quality improvement project experience. J Pediatr Nurs. 2017;32:72-79. https://doi.org/10.1016/j.pedn.2016.10.004.
Bedwell JR, Pandian V, Roberson DW, McGrath BA, Cameron TS, Brenner MJ. Multidisciplinary tracheostomy care: how Collaboratives drive quality improvement. Otolaryngol Clin N Am. 2019;52(1):135-147. https://doi.org/10.1016/j.otc.2018.08.006.
Chorney SR, Brown AF, Brooks RL, et al. Pediatric tracheostomy outcomes after development of a multidisciplinary airway team: a quality improvement initiative. OTO Open. 2021;5(3):2473974X211045615.
Rawal RB, Farquhar DR, Kilpatrick LA, Drake AF, Zdanski CJ. Considering a weight criterion for neonatal tracheostomy: an analysis of the ACS NSQIP-P. Laryngoscope. 2019;129(2):500-505.
Rosner E, Mastropietro CW. Prior cardiac surgery is independently associated with decreased survival following infant tracheostomy. Respir Care. 2015;60(1):47-55. https://doi.org/10.4187/respcare.03392.
Maxwell BG, McMillan KN. Tracheostomy in children with congenital heart disease: a national analysis of the kids' inpatient database. PeerJ. 2014;2:e568. https://doi.org/10.7717/peerj.568.
Berry JG, Graham DA, Graham RJ, et al. Predictors of clinical outcomes and hospital resource use of children after tracheotomy. Pediatrics. 2009;124(2):563-572. https://doi.org/10.1542/peds.2008-3491.
McPherson ML, Shekerdemian L, Goldsworthy M, et al. A decade of pediatric tracheostomies: indications, outcomes, and long-term prognosis. Pediatr Pulmonol. 2017;52(7):946-953. https://doi.org/10.1002/ppul.23657.
Sillers L, Lioy J, Moran K, Stow J, Jacobs IN, DeMauro SB. Survival and decannulation across indications for infant tracheostomy: a twelve-year single-center cohort study. J Perinatol. 2022;42(1):72-78.