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Surveillance endoscopy after tracheostomy placement in children: Findings and interventions
Author(s) -
Liu C. Carrie,
Soares Jennifer J.,
Elder Leslie,
Hill Leslee,
Abts Matthew,
BonillaVelez Juliana,
Dahl John P.,
Johnson Kaalan E.,
Ong Thida,
Striegl Amanda M.,
Whitlock Kathryn,
Parikh Sanjay R.
Publication year - 2020
Publication title -
the laryngoscope
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.181
H-Index - 148
eISSN - 1531-4995
pISSN - 0023-852X
DOI - 10.1002/lary.28247
Subject(s) - medicine , airway , interquartile range , endoscopy , glottis , subglottic stenosis , psychological intervention , odds ratio , airway obstruction , logistic regression , retrospective cohort study , surgery , larynx , psychiatry
Objectives/Hypothesis The Seattle Children's Hospital implemented the Trach Safe Initiative to improve airway safety in tracheostomy‐dependent children (TDC). A key tenet of this initiative is surveillance endoscopy. The objectives of this study were to describe the prevalence of abnormal airway changes in TDC, identify risk factors for these changes, and describe the frequency of airway interventions. Study Design Retrospective case series. Methods This is a review of children 0 to 21 years old who underwent tracheostomy and surveillance endoscopy from February 1, 2014 to January 1, 2019. Descriptive statistics were used to report the prevalence of abnormal airway changes and interventions following tracheostomy. Pearson χ 2 tests and logistic regression were used to identify risk factors for the development of abnormal changes. Results There were 127 children identified. The median time from tracheostomy to initial surveillance endoscopy was 1.6 months (interquartile range = 1.3–2.4 months). At initial endoscopy, 86.6% of patients had at least one abnormal airway finding. The most common findings were subglottic edema/stenosis (57.3%), glottic edema (37.3%), and suprastomal granulation tissue (31.8%). Prematurity and a history of failed extubations were significantly associated with abnormal findings on endoscopy (odds ratio [OR] = 7.2, P = .01 and OR = 4.1, P = .03, respectively). Of those with abnormal findings, 32.7% underwent an intervention to improve airway patency and safety. The most common interventions performed were suprastomal granuloma excision (44.4%), steroid injection (22.2%), and balloon dilation of the glottis or subglottis (19.4%). Conclusions The prevalence of early abnormal airway changes in TDC is high, particularly in young children with a history of prematurity and failed extubation. Level of Evidence 4 Laryngoscope , 130:1327–1332, 2020