Outcomes Of Tracheostomy Research Articles

Outcomes of tracheostomy following congenital heart surgery: a contemporary experience.

Following congenital heart surgery, pediatric patients may experience persistent respiratory failure that requires tracheostomy placement. Currently, definitive knowledge of the optimal timing for tracheostomy placement in this patient population is lacking. An 8-year retrospective review of 17 pediatric patients who underwent congenital heart surgery and subsequently required tracheostomy placement was performed. Patients were evaluated with regard to the timing of tracheostomy and mortality. The overall study mortality was 24%. The median duration of intubation prior to tracheostomy was 60 days (interquartile range: 19-90 days); there was no difference in the average time between intubation and tracheostomy for survivors compared with nonsurvivors (51 vs. 73 days, P = .37). No difference was observed in the overall duration of positive pressure ventilation when tracheostomy was performed within 30 days of intubation compared with greater than 30 days following intubation (481 vs. 451 days, P = .88). Overall, 18% of patients were successfully weaned from the ventilator after a median duration of positive pressure ventilation of 212 days. The timing of tracheostomy placement may be an important factor in clinical outcomes for pediatric patients with persistent dependence on mechanical ventilatory support following congenital heart surgery. A larger, multi-institution study may help further elucidate our observed clinical findings in this patient population.

Outcomes of tracheostomy in the neonatal intensive care unit: is there an optimal time?

Objective: To compare short-term outcomes of infants who underwent early versus late tracheostomy during their initial hospitalization after birth and determine the association, if any, between tracheostomy timing and outcomes.Study design: Retrospective chart review of infants who underwent a tracheostomy during their initial hospitalization at a single site.Results: The median (range) gestational age of our cohort (n = 127) was 28 (23–42) weeks and birth weight was 988 (390–4030) g. Tracheostomy indications included airway lesions (47%), bronchopulmonary dysplasia (25%), both (22%) and others (6%). Median postmenstrual age (PMA) at tracheostomy was 45 (35–75) weeks. Death occurred in 27 (21%) infants and 65 (51%) infants were mechanically ventilated. G-tube was present at discharge in 42 (33%) infants. Infants who underwent early tracheostomy (<45 weeks PMA) (n = 66) had significantly lower gestational ages, weights and respiratory support than the late (≥45 weeks PMA) (n = 61) group. Death (29.5% versus 14%), home ventilation (41% versus 21%) and G tube (44% versus 14%) were significantly more frequent in the late tracheostomy group. On bivariate regression, outcomes were not independently associated with tracheostomy timing, after adjustment for gestational age and respiratory support.Conclusions: Of infants who underwent tracheostomy during the initial hospitalization after birth, 21% died. On adjusted analysis, tracheostomy timing was not independently associated with outcomes.

Indications and outcomes of tracheostomy: An experience in a resource-limited environment

Background: Tracheostomy remains one of the most important procedures for airway emergency management, especially in a developing country where patients will not present until they are in acute airway obstruction. This study reviews all the tracheostomies performed in a suburban tertiary health institution in a developing country. Materials and Methods: A retrospective review of patients who had tracheostomy over a 10-year period. Results: There were 52 tracheostomies performed on 36 males and 16 females with a male: Female ratio 2.3:1. Upper airway obstruction was the major indication (63.5%), with laryngeal tumor as the major cause (32.7%). Tracheostomy was performed as emergency in 76.9% and as elective in 23.1%. Majority (73.1%) of the emergency tracheostomies was done under general anesthesia and over 84% were temporary tracheostomies. There were 21.2% complications with tracheostomy dependence as the leading cause in 9.6%, followed by peri-stoma granulation in 5.8%. Conclusion: Upper airway obstruction remains the major indication for tracheostomy, with laryngeal tumor as the major cause. There is a need for increased awareness of the people through social campaigns and health education on the merits of early detection and improvement in health-seeking behaviors of the people.

Admission ASIA motor score predicting the need for tracheostomy after cervical spinal cord injury

Respiratory compromise and the need for tracheostomy are common after cervical spinal cord injury (cSCI). The purpose of the study was to evaluate if admission American Spinal Injury Association (ASIA) motor score is associated with the need for tracheostomy following cSCI. The trauma registry identified patients with isolated cSCI during a 3-year period. Patients with an Abbreviated Injury Scale score greater than 3 in other body regions were excluded. Medical records were reviewed for demographics, admission ASIA motor score, ASIA Impairment Scale (AIS), anatomic level of injury, need for a tracheostomy, and length of stay (LOS). Logistic regression models were constructed to examine the effect of admission ASIA motor scores on the outcome of tracheostomy. Cox proportional hazards models were fit to determine risk factors for time to tracheostomy. A total of 128 patients were identified. Seventy-four patients had a tracheostomy performed on mean (SD) hospital Day 9 (4). Median admission ASIA motor score was 22.0 (interquartile range [IQR], 8-54). Median anatomic level of injury was 5 (IQR, 4-6). Patients requiring tracheostomy had significantly lower median admission ASIA motor score (9 [IQR, 3-17] vs. 57 [IQR, 30-77], p < 0.001) and were more likely to be an AIS A. There was no difference in median anatomic level of injury (5 [IQR, 4-5.8] vs. 5 [IQR, 4-6], p = nonsignificant). ASIA motor scores less than 10 had an unadjusted odds ratio for requiring tracheostomy of 56 (95 confidence interval, 7-426). Following adjustment for independent risk factors, the odds ratio for ASIA motor score less than 10 remained statistically significant at 22 (confidence interval, 3-180). Among patients with incomplete cSCI, ASIA motor scores increased significantly from AIS B to AIS D, while Injury Severity Score (ISS), LOS and intensive care unit LOS declined significantly. Of those patients without a tracheostomy, 100% had an ASIA motor score greater than 10, 98% had an ASIA motor score greater than 20, and 86% had an ASIA motor score greater than 25. Among patients with an ASIA motor score less than 10, 100% had a tracheostomy; among patients with an ASIA motor score less than 20, 96% had a tracheostomy. Among patients with a tracheostomy, 91% were an AIS B or C, while 85% of patients classified as AIS D did not have a tracheostomy. Tracheostomy after cSCI is common. Lower admission ASIA motor score and "complete" cSCI are significantly associated with the need for tracheostomy. Anatomic level of injury was not associated with tracheostomy after cSCI. Classification of incomplete patients by AIS indicates that ASIA motor score may be used as a surrogate for grade of injury. When looking only at patients with an "incomplete" cSCI, those with an admission ASIA score of less than 10 should have an early tracheostomy. Those with an AIS D scale should not be considered for early tracheostomy. Therapeutic/care management, level II.

Predictors and outcomes of tracheostomy after traumatic brain injury

McKenna, John William BS; Wilson, Laura D. MS; Song, Yanna MS; Davidson, Mario A. PhD; Humble, Stephen S. BS; Ehrenfeld, Jesse M. MD, MPH; Guillamondegui, Oscar D. MD, MPH, FACS; Pandharipande, Pratik P. MD, MS; Patel, Mayur B. MD, MPH, FACS Author Information

Single-center Experience of Outcomes of Tracheostomy in Children with Congenital Heart Disease

A subset of children with repaired congenital heart disease (CHD) may require tracheostomy for ongoing ventilatory support. Data on outcomes of children with CHD and tracheostomy are scarce. Our objectives were to describe indications for tracheostomy and outcomes, including readmission data in this population. This is a retrospective chart review of children (<18 years old) with CHD who underwent tracheostomy at a single center over a 12-year period. Exclusion criteria were prematurity with isolated patent ductus arteriosus ligation. Outcomes until discharge and data on all readmissions after the initial discharge were reviewed. A total of 21 subjects with CHD underwent tracheostomy at a median (range) age of 4 (1-84) months and mean (standard deviation) weight of 7.2 (5.9) kg. The most common indication for tracheostomy was tracheomalacia with ventilator-dependent respiratory failure (14/21 subjects), followed by subglottic stenosis (5) and vocal cord palsy (2). Genetic syndromes were present in 13 (62%) subjects. The mean (standard deviation) post-tracheostomy length of stay was 55 (35) days. All subjects survived to discharge; 17 (81%) required home ventilation. A total of 11 (52%) subjects died during follow-up, all of whom were mechanically ventilated while three (14%) children underwent successful decannulation. The mean number of nonelective readmissions decreased from 2.4/patient-year in the first year to 1.4/patient-year in the second year, respectively. The commonest reasons for readmission were respiratory deterioration, infections, and mechanical tracheostomy-related problems. The majority of children with CHD who underwent tracheostomy did so for ventilator dependence and tracheomalacia and had coexisting genetic syndromes. About half the cohort died; among survivors, readmissions were common but decreased after the first year. These results underscore the ongoing mortality and morbidity risks faced by this vulnerable population.

Outcome of tracheostomy after pediatric cardiac surgery

ObjectiveTo investigate the incidence, timing indications and outcome of tracheotomy in children who underwent cardiac surgeries. MethodsAll pediatric cardiac patients (under 14years of age) who underwent cardiac surgeries and required tracheotomy from November 2000 to November 2010 were reviewed. The data were collected and reviewed retrospectively. ResultsSixteen children underwent tracheotomy after cardiac surgery. Fifteen of these cases had surgery for congenital heart disease, and one had surgery for an acquired rheumatic mitral valve disease. The mean±SEMs of the durations of ventilation before and after tracheotomy were 60.4±9.8 and 14.5±4.79days respectively (P value 0.0002). The means±SEM of the lengths of ICU stay before and after tracheotomy were 63.31±10.15 and 22±5.4days respectively (P value 0.0012). After the tracheotomy 12/16 patients (75%) were weaned from their ventilators and 10/16 were discharged from the PCICU. Six patients were discharged from the hospital and 3 were successfully decannulated. The overall survival rate was 9/16 (56%). ConclusionTracheostomy shortens the duration of mechanical ventilation and facilitates discharge from the ICU. The mortality of tracheotomy patients is still significant but is mainly related to the primary cardiac disease.

Causes and Outcome of Tracheostomy in Children

Purpose: Tracheostomy is used to aid airway management in perdiatric respiratory care. This study was designed to review causes and outcomes of pediatric tracheostomy. Methods: We performed a retrospective chart review of 153 patients, less than 18 years of age, who underwent tracheostomy between January 1995 and July 2010. Age at tracheostomy, indications, durations, complications and mortality were evaluated. Results: Subglottic stenosis (19%) was the most common indication for tracheostomy. The median age at tracheostomy was 1.3 years (range, 22 days to 17.8 years). Seventy-three (47.7%) tracheostomies were performed in children under 1 year of age. Respiratory diseases were significantly more prevalent in patients under 1 year of age, while neuromuscular disease were more frequently found in patients older than 1 year (P=0.013). Stoma or tracheal granuloma formation (36.6%) was the most common complication of pediatric tracheostomy. Decannulation was accomplished in 61 (39.9%) patients with median cannulation time of 141 days (range, 1 to 2,529 days). Overall mortality rate was 10.5% (n=16), but only one patient (0.7%) died from tracheostomy-related complications. Conclusion: Respiratory diseases, such as subglottic stenosis and neuromuscular disease, are the main cause of pediatric tracheostomy. Although complications, like stoma or tracheal granuloma formation occur, tracheostomy in children is a safe way to aid airway management. [Pediatr Allergy Respir Dis(Korea) 2012;22:188-196]

Evaluation of Early vs Late Tracheostomy Outcomes in Different Subpopulations of Critically Ill Patients

Evaluation of Early vs Late Tracheostomy Outcomes in Different Subpopulations of Critically Ill Patients

Tracheostomy in burns patients revisited

Objective The use of tracheostomy in burns patients has been controversial. A retrospective study was conducted to assess the use, complications and outcome of tracheostomy in ventilated adult burns patients. Methods Data was collected retrospectively regarding the extent of injury in each patient, the indication for tracheostomy, and outcome in terms of length of stay, days of mechanical ventilation, airway and pulmonary complications and survival. Patients were followed until discharge from the unit or death. Results Comparing patients who received tracheostomy to those who had translaryngeal intubation showed similar age distribution and no significant difference in the total burn surface area (TBSA). The use of tracheostomy was significantly higher in patients with TBSA >60%. Inhalation injury was significantly higher and mean probability of survival (ABSI), significantly lower in patients receiving tracheostomy. Duration of mechanical ventilation, length of stay in HDU/ITU and the incidence of pulmonary sepsis were significantly higher in tracheostomy group patients. However, there was no significant difference in mortality between the two groups. Conclusion Burn survivors with TBSA >60% are more likely to undergo repeated surgery and have burns to the head and neck region, therefore increasing the requirement for tracheostomy. Tracheostomy is a safe procedure with minimal perioperative complications. Late complications in this patient group may be related to duration of intubation and mechanical ventilation and the presence of an airway burn. Tracheostomy was associated with a higher prevalence of chest infection. We suspect that the cause of this is multifactorial, possibly due to a higher incidence of inhalation injury, greater burn size and prolonged mechanical ventilation in this group.

Outcome of tracheostomy in patients over 85 years old (oldest-old patients)

To investigate morbidity, complication rate, and mortality in oldest-old patients who undergo tracheostomy. Historical cohort study. The medical records for 64 patients (>85 years) who underwent standard or percutaneous tracheostomy between 2001 and 2005 in a tertiary care hospital were reviewed for in-hospital and out-of-hospital mortality, complications, and decannulation rate. Twenty-eight (43.8%) patients were discharged from the hospital and all remained tracheotomized at that time. Postoperative mortality had not been related to the procedure itself and the mortality rate reached 75 percent within the first three postoperative months and 93.8 percent within the first year post-tracheostomy. The post-tracheostomy course was complicated in three (4.7%) patients. There was no significant correlation between the length of hospital stay or survival and demographic parameters, pneumonia as the reason for mechanical ventilation, or performance of surgery before tracheostomy. Tracheostomy is a safe surgical procedure in the oldest-old patients. The high rate of the postoperative mortality is not related to the procedure itself. The possibility of permanent stoma should be considered and discussed with the patients and their families during the preoperative counseling.

S265 – Tracheostomy in Bronchopulmonary Dysplasia

Objectives To characterize pediatric patients undergoing tracheotomy for bronchopulmonary dysplasia (BPD). To examine the effects of tracheomalacia on tracheostomy outcomes in these patients. Methods The medical records of 95 patients with BPD who underwent tracheotomy in an academic tertiary care children's hospital over 8 years were evaluated for gestational age, birthweight, ethnicity, gender, co-morbid conditions, duration of ventilator support, duration of hospitalization, number of failed extubation attempts before tracheotomy, age at tracheotomy, and time to decannulation. Results The average gestational age was 28.9 weeks and the average postnatal age at tracheotomy was 27.6 weeks after having failed an average of 1.2 extubation attempts. The patients averaged 268.2 days of hospitalization, with 41.6% still requiring ventilator support and 57.1% still having tracheostomy at the end of the study. Of 27 patients with tracheomalacia, 4 (15%) were eventually decannulated vs. 36 of 68 patients without tracheomalacia (53%). The average time to decannulation among patients with tracheomalacia was 27.4 months and without tracheomalacia was 25.7 months. Decreased gestational age correlated with increased time to decannulation (Cox regression analysis, p=0.035). Of patients with genetic anomalies, 22.7% were eventually decannulated vs. 49.3% of patients without genetic anomalies (p = 0.027). Conclusions This study describes the characteristics of patients undergoing tracheotomy for BPD and begins to clarify the relationship between BPD and tracheomalacia. The presence of tracheomalacia in patients with BPD correlates with decreased likelihood of decannulation, but does not significantly affect time to decannulation. As such, tracheomalacia may be an independent risk factor for worse tracheostomy prognosis.

Outcome of mechanically ventilated patients who require a tracheostomy*

To estimate the prevalence of, the risk factors associated with, and the outcome of tracheostomy in a heterogeneous population of mechanically ventilated patients. Prospective, observational cohort study. A total of 361 intensive care units from 12 countries. A cohort of 5,081 patients mechanically ventilated for >12 hrs. None. A total of 546 patients (10.7%) had a tracheostomy during their stay in the intensive care unit. Tracheostomy was performed at a median time of 12 days (interquartile range, 7-17) from the beginning of mechanical ventilation. Variables associated with the performance of tracheostomy were duration of mechanical ventilation, need for reintubation, and neurologic disease as the primary reason of mechanical ventilation. The intensive care unit stay of patients with or without tracheostomy was a median of 21 days (interquartile range, 12-32) vs. 7 days (interquartile range, 4-12; p < .001), respectively, and the hospital stay was a median 36 days (interquartile range, 23-53) vs. 15 days (interquartile range, 8-26; p < .001), respectively. Adjusting by other variables, tracheostomy was independently related with survival in the intensive care unit (odds ratio, 2.22; 95% confidence interval, 1.72-2.86). Mortality in the hospital was similar in both groups (39% vs. 40%, p = .65). Tracheostomy is a common surgical procedure in the intensive care unit that is associated with a lower mortality in the unit but with a longer stay and a similar mortality in the hospital than in patients without tracheostomy.

Tracheostomy in Preterm Infants

To study the indications for and outcomes of tracheostomy in a population of preterm infants. Retrospective analysis of case records. Two university-affiliated tertiary care children's hospitals. Patients We identified premature infants who required tracheostomies from January 1, 1997, through January 31, 2001. Information on weight, gestational age, comorbid conditions, indication for tracheostomy, and outcomes was collected. Infants were divided by birth weight into group 1 (<1000 g; n = 19 [very low birth weight]) and group 2 (> or =1000 g; n = 14). Comorbid conditions were scored and a total score was calculated for each patient. Group 1 had a higher incidence of patent ductus arteriosus, bronchopulmonary dysplasia, intraventricular hemorrhage, and retinopathy of prematurity. The incidence of congenital or genetic defects was equal in groups 1 and 2 (11 infants [58%] and 8 infants [57%], respectively). Group 1 had a higher average number of failed extubations (5.17 vs 3.18) and a higher oxygen requirement (48.7% vs 30.3%) compared with group 2. Weight at tracheostomy was essentially equal in groups 1 and 2 (3.6 vs 3.7 kg). Subglottic stenosis and laryngotracheomalacia were equally common findings in groups 1 and 2. The average comorbidity score for group 1 was higher than that for group 2 (6.7 vs 2.8). The most common indication for tracheostomy was ventilatory dependence (n = 24 [73%]), compared with airway obstruction (n = 6 [18%]) and pulmonary toilet (n = 3 [9%]). Overall, 6 patients (18%) had a complication related to the tracheostomy. Severity of pulmonary disease was the most significant factor associated with the need for tracheostomy in preterm infants. A tracheostomy can safely be performed in these infants with minimal morbidity.

The outcome of tracheostomy in children.

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Tracheostomy in acute respiratory failure: effects assessed by arterial blood gases.

AbstractThe effects of tracheostomy in 27 patients with severe respiratory difficulty are described in terms of arterial blood gas values and clinical observations. Postoperatively, mouth breathing was compared with tracheostomy breathing.Obstruction of the lower respiratory tract from accumulated secretions leads to hypoventilation, ineffective coughing, carbon dioxide retention, anoxia and coma. In such cases, tracheostomy may be life‐saving because it provides a reliable pathway: a) for suctioning the secretions (which may be unusually abundant in emphysema with bronchitis), and b) for the administration of artificial respiration.An important factor in the outcome of tracheostomy is meticulous postoperative care. Attention to such things as proper tube alignment and proper suctioning techniques goes a long way toward preventing possible mucosal damage and infection. Tracheostomy provides therapeutic relief even to patients who are gravely ill (narcosis, coma) with emphysema and bronchitis.