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A decade of pediatric tracheostomies: Indications, outcomes, and long‐term prognosis
Author(s) -
McPherson Mona L.,
Shekerdemian Lara,
Goldsworthy Michelle,
Minard Charles G.,
Nelson Cynthia S.,
Stein Fernando,
Graf Jeanine M.
Publication year - 2017
Publication title -
pediatric pulmonology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.866
H-Index - 106
eISSN - 1099-0496
pISSN - 8755-6863
DOI - 10.1002/ppul.23657
Subject(s) - medicine , retrospective cohort study , cohort , pediatrics , intensive care unit , airway obstruction , intensive care , disease , cohort study , airway , surgery , intensive care medicine
Summary Objective To define the mortality and long‐term outcomes of children undergoing tracheostomy. Design Retrospective chart and Texas Department of Health Bureau of Vital Statistics review of patients admitted to a Pediatric Intensive Care Unit who underwent a tracheostomy between 2001 and 2011. Mortality and decannulation rates were compared based on tracheostomy indication and age. Subjects A total of 426 patients admitted to a Pediatric Intensive Care Unit in a large tertiary children's hospital. Results The median patient age was 1.5 years (3 days–24 years). Primary indications for tracheostomy included (a) airway obstruction, (b) congenital neurologic disease, (c) acquired neurologic disease, (d) congenital respiratory disease, and (e) acquired respiratory disease. Overall, 98 patients (23%) died during the study period, and 75th percentile survival time was 5.9 years (95%CI: 3–8). Patients undergoing a tracheostomy for airway obstruction were the least likely to die; while patients with acquired neurologic disease were most likely to die. A total of 163 patients (38%) were decannulated, and 50% were decannulated at 1.2 years (95%CI: 0.9–1.5). Patients with congenital neurologic disease were the least likely to undergo decannulation. Over half of the patients were discharged from the hospital requiring some form of mechanical respiratory support in addition to their tracheostomy. Conclusions In this largest cohort of long‐term follow‐up to date, we have shown the overall risk of mortality varied according to the indication for the tracheostomy. We were unable to determine exact causes of death. The likelihood of being decannulated also correlates with the underlying indication for the tracheostomy. Pediatr Pulmonol. 2017; 52:946–953. © 2017 Wiley Periodicals, Inc.