Mortality and Outcomes of Pediatric Tracheostomy Dependent Patients.

Kiran B Hebbar,Kara K Prickett,Courtney E Mccracken,Ajay S Kasi,Dawn M Simon,Caroline C Ivie,Monica Vielkind

doi:10.3389/fped.2021.661512

Kiran B Hebbar, Kara K Prickett + Show 5 more

Open Access

https://doi.org/10.3389/fped.2021.661512

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Abstract

Objective: To describe clinical factors associated with mortality and causes of death in tracheostomy-dependent (TD) children.Methods: A retrospective study of patients with a new or established tracheostomy requiring hospitalization at a large tertiary children's hospital between 2009 and 2015 was conducted. Patient groups were developed based on indication for tracheostomy: pulmonary, anatomic/airway obstruction, and neurologic causes. The outcome measures were overall mortality rate, mortality risk factors, and causes of death.Results: A total of 187 patients were identified as TD with complete data available for 164 patients. Primary indications for tracheostomy included pulmonary (40%), anatomic/airway obstruction (36%), and neurologic (24%). The median age at tracheostomy and duration of follow up were 6.6 months (IQR 3.5–19.5 months) and 23.8 months (IQR 9.9–46.7 months), respectively. Overall, 45 (27%) patients died during the study period and the median time to death following tracheostomy was 9.8 months (IQR 6.1–29.7 months). Overall survival at 1- and 5-years following tracheostomy was 83% (95% CI: 76–88%) and 68% (95% CI: 57–76%), respectively. There was no significant difference in mortality based on indication for tracheostomy (p = 0.35), however pulmonary indication for tracheostomy was associated with a shorter time to death (HR: 1.9; 95% CI: 1.04–3.4; p = 0.04). Among the co-morbid medical conditions, children with seizure disorder had higher mortality (p = 0.04).Conclusion: In this study, TD children had a high mortality rate with no significant difference in mortality based on indication for tracheostomy. Pulmonary indication for tracheostomy was associated with a shorter time to death and neurologic indication was associated with lower decannulation rates.

Highlights

Advances in pediatric critical care medicine have increased survival of complex medical patients for whom tracheostomy and/or home mechanical ventilation is required [1, 2]
Several studies have reported risk factors associated with increased mortality and decannulation outcomes in tracheostomy dependent (TD) children, almost 50% of deaths were unexpected [5,6,7, 11, 17]
Patients were excluded if there was no information pertaining to tracheostomy placement or if the patient were transferred to another facility during the study period

Summary

Introduction

Advances in pediatric critical care medicine have increased survival of complex medical patients for whom tracheostomy and/or home mechanical ventilation is required [1, 2]. Indications for tracheostomy have broadened over time and include more chronic medical conditions such as neurologic disease and chronic respiratory failure requiring home mechanical ventilation [3,4,5]. These chronic conditions pose challenges to clinicians when counseling families of the potential benefits and outcomes after tracheostomy [3, 6]. Several studies have reported risk factors associated with increased mortality and decannulation outcomes in TD children, almost 50% of deaths were unexpected [5,6,7, 11, 17]. The objectives of this study were to: [1] identify the mortality rate, [2] identify risk factors that are associated with increased mortality, and [3] describe the causes of mortality in our TD cohort

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Results

Discussion

Conclusion