Tracheostomy

A number of children with T18 require tracheostomy, either to manage upper airway issues or to enable home ventilation for a variety of reasons. This treatment is not always offered to children with T18 in the UK. Towards the end of Rumer's life we were pursuing tracheostomy and home ventilation for her and we did some research on this, particularly on the outcomes, ethics and doing it at a smaller size (in our hospital, they were reluctant below 3.5kg). This is all that research in date order. 


Tracheostomy in children: a population based experience over 17 years (Al Samri M et al ) 2010
Looks at tracheostomies in 72 children in one area. High rates of infection (90% improvement) but only 1 tracheostomy related death.  Abstract only. Health Professionals can access via OpenAthens. Article available for purchase.
 
Predictors of clinical outcome and hospital resource use of children after tracheotomy (Berry J et al) 2009
Looked at a large cohort of children (917) undergoing tracheostomy at 36 US hospitals, over 5 years (2002-2007). Just under half of the children were aged under 6 months when undergoing tracheostomy. Reports lower mortality of children with upper airway anomalies than for children with neurological impairment. Relatively high mortality reported overall. 11.1% of children with neurological impairment died during the initial hospitalisation for tracheostomy placement. Children with T18 universally have neurological impairment as defined in this study but are often given tracheostomy for upper airway anomalies. It is unclear from this study how the primary reason for tracheostomy impacts on mortality when children have other co-morbidities.  Abstract only. Health Professionals can access via OpenAthens. Article available for purchase.

The impact of pediatric tracheostomy on both patient and parent (Hopkins C et al) 2009
Study looking at how paediatric tracheostomy impacts children and parents. Parents reported negative impact on social lives, sleep, relationships and ability to work. They also were of a lower income than average for the area though whether this was because they had a child with a disability or they were of lower income before they had their child is not specfied. Study suggests more support is needed to avoid the high impact on quality of life for parents. Abstract only. Health Professionals can access via OpenAthens. Article available for purchase.

Pediatric tracheostomies: a recent experience from one academic center (Graf J et al) 2008
Looks at a cohort of children and adolescents undergoing tracheostomy. Identifies a number of reasons for tracheostomy. No tracheostomy related mortality but overall mortality was 13%. High number of children on long term ventilation. This group had longer hospital stays and more readmissions than others.


Tracheostomy- a 10 year experience from a UK pediatric surgical center (Corbett H et al) 2007
Discusses patients receiving tracheostomy between 1994 and 2004 in one centre. Younger patients are an increasing group. There was relatively high morbidity but relatively low mortality (2/112) Abstract only. Available for purchase

Pediatric tracheotomy: a 17 year review (MahadevanM et al) 2007
Looks at tracheostomy in an NZ hospital. Low tracheostomy related mortality (1.6%) but 13% mortality overall. Around half of patients had complications. Around 75% were successfully decannulated.  

Tracheotomy in the first year of life: outcomes in term infants, the Vanderbilt experience. (Wootten C et al) 2006
Looks at outcomes in infant tracheostomy in term infants, finds high rates of overall mortality but better outcomes for term than preterm infants. Low tracheostomy related mortality

Outcome for patients requiring tracheostomy in a pediatric intensive care unit (Sergio P et al) 2005
 Study found lower long term survival rates for patients undergoing tracheostomy than those who did not though short term survival rates were better for this group. Suggests further research to determine which children will benefit from tracheostomy.

Pediatric tracheostomy- a 13 year experience (Alladi A et al) 2004
 A study examining the outcomes of a small cohort (39) children who received tracheostomy. Reported complications were minor and transient. Mortality was similar to that reported in other studies 1/39. Most patients were infants (a third were newborns) and indications were tracheostomy were all obstructive airway issues. The majority of patients were successfully decannulated. Abstract only. Health Professionals can access via OpenAthens. Article available for purchase.

Sending children home on tracheostomy dependent ventilation: pitfalls and outcomes (Edwards E et al) 2004
Looks at the complex discharge process in the UK for getting children home on tracheostomy ventilation. Our experience with other families in the ward Rumer was on is that it hasn't changed. It was a long process to get children home in this study and some didn't get home. Funding problems, housing problems and recruiting carers all delayed discharge. Some children experienced long hospitalisations with a negative impact on their quality of life.

The changing indications for pediatric tracheostomy (Hadfield P et al) 2003
Looked at indications for pediatric tracheostomy, requiring prolonged ventilation was the most common indicator overall. Abstract only. Health Professionals can access via OpenAthens. Article available for purchase.

Tracheostomy in preterm infants (Pereira K et al) 2003
A study looking at tracheostomy in preterm infants. Useful for babies with T18 who tend to be of similar size. Primary indication for tracheostomy was ventilator dependence. A low rate of complications (18%). There was a high rate of co-morbidities in this group. Those with co-morbidities had higher mortality.

Outcome in pediatric tracheotomy (Tantinikorn W et al) 2003
Looked at reasons for and outcome of pediatric tracheostomy in one centre in the US. The most common indication in this study was airway obstruction, with prolonged ventilation secondary. This may suggest a difference in how airway obstruction is initially managed in the UK and the US. Outcomes were good with low tracheostomy related mortality 1/118 but relatively high morbidity. Abstract only. Health Professionals can access via OpenAthens. Article available for purchase.

Indications, complications and surgical techniques for pediatric tracheostomies- an update (Kremer et al) 2002
Examines the literature and the authors' experiences of a small cohort of children who had tracheostomy. Identifies a wide range of reasons for tracheostomy. Authors believe their tracheostomy technique is superior in avoiding accidental deccanulation. There were no deaths in their small cohort. Abstract only. Health Professionals can access via OpenAthens. Article available for purchase.

Complications in pediatric tracheostomies (Carr M et al) 2001
Looks at the complication rate in pediatric tracheostomy. Death attribute to tracheostomy occured in 0.7% of patients. Around 43% had at least one serious complication such as tube occlusion or accidental decannulation or needed a seperate surgical procedure. Abstract only. Health Professionals can access via OpenAthens. Article available for purchase.

Early versus late tracheostomy in patients who require long term ventilation (Brook A et al) 2000
Looks at a cohort of adult patiens requiring tracheostomy due to the need for LTV and concludes earlier tracheostomy reduces length of stay and  hospital costs. Unclear if this would also be applicable to children/infants. 

Developmental sequale of long term infant tracheostomy (Singer L et al) 1989
A very old article looking at development of infants with tracheostomy. Noted high rates of developmental difficulties even in children without underlying disability.