Prevalence of Airway Abnormality after Tracheotomy at a Tertiary Safety Net Children’s Hospital
Abstract
Introduction: Over 4500 pediatric tracheotomies are performed an-nually in the United States. However, there is no consensus on the appropriate time for surveillance endoscopy. The St. Christopher’s Hospital for Children implemented the Trach Safe Initiative to improve airway safety in tracheotomy-dependent children. A major component of this initiative is surveillance endoscopy. The objectives of this study are to describe the prevalence of abnormal airway changes in trach dependent patients, to identify and describe the frequency of airway interventions, and to ultimately minimize morbidity in this population.
Method: A report consisting of a list of patients meeting our inclusion criteria was generated using CPT codes for tracheotomy and direct bronchoscopy and laryngoscopy at SCHC. A retrospective chart review of patients under the age of 18 who has had a tracheotomy from 2010 to 2020 was conducted in order to describe airway abnormalities after tracheotomy quantitatively and
qualitatively.
Result: 55 patients met inclusion criteria and were included in our study. Our study found the overall rate of abnormal findings on
en-doscopy after tracheotomy is 72.7 % (p < 0.05). The average time from tracheotomy to the time of initial surveillance endoscopy at SCHC was 884 days (95%CI 684 -1084). The most common abnormal finding was granulation tissue (29.1%), followed by supra-stomal collapse (12.7%), and subglottic stenosis (12.7%). 58.2% of patients undergoing endoscopy had an intervention. The most common intervention during endoscopy was excision of granulation tissue (25.4%) and trach change (23.6%) followed by tracheoplasty/stomoplasty (7.2%). Conclusion:Our study found a high rate of airway abnormality on surveillance endoscopy with a significant percentage of our patients requiring airway intervention. Our findings necessitate a guideline for routine surveillance endoscopy for our tracheotomy patients and the development of a database tracking airway abnormalities of patients in order to prepare a safe airway plan.
References
Watters KF. Tracheostomy in Infants and Children. Respir Care. 2017 Jun;62(6):799-825. doi: 10.4187/respcare.05366. PMID: 28546379.
Mehta AK, Chamyal PC. TRACHEOSTOMY COMPLICATIONS AND THEIR MANAGEMENT. Med J Armed Forces India. 1999;55(3):197–200. doi:10.1016/S0377-123 7(17)30440-9.
Oliver BG. Complications of tracheostomy in Paediatric Patients. Ear Nose and Throat Monthly. 1985; 54:346–349.
Dempsey GA, Morton B, Hammell C, Williams LT, Smith T, Jones C, et al. Long-Term Outcome Following Tracheostomy in Critical Care: A Systematic Review. Crit Care Med. 2016;44(3):617–628. doi:10.1097/CCM.0000000000001382.
Sherman JM, Davis S, Albamonte-Petrick S. Care of the child with a chronic tracheostomy. Am J Respir Crit Care Med. 2000;161:297–308.
Carr MM, Poje CP, Kingston L, Kielma D, Heard C; 2001. Available from: https://doi.org/ 10.1097/00005537-200111000-00010. doi:10.1 097/00005537-200111000-00010.
Gergin O, Adil E, Kawai K, Watters K, Moritz E, Rahbar R. Routine airway surveillance in pediatric tracheostomy patients. Int J Pediatr Otorhinolaryngol. 2017;97:1–4. doi:10.1016/j.i jporl.2017.03.020.
Lyon R, Reeves PJ. An investigation into why patients do not attend for out-patient radiology appointments. Radiography. 2006;12(4):283–290.
Smith MM, Alarcon AD, Meinzen-Derr J. Timing of Initial Posttracheostomy Surveillance Endoscopy in Pediatric Patients. Otolaryngology- Head and Neck Surgery. 2020;162(3):362–366. doi:10.1177/0194599819900900.
Ong T, Liu CC, Elder L, Hill L, Abts M, Dahl JP, et al. The Trach Safe Initiative: a quality improvement initiative to reduce mortality among pediatric tracheostomy patients. Otolaryngology-Head and Neck Surgery. 2020;163(2):221–231.
Colman KL, Mandell DL, Simons JP. Impact of stoma maturation on pediatric tracheostomy-related complications. Archives of Otolaryngology-Head & Neck Surgery.2010;136(5):471–474.
