Author(s)
R. E. Park
P. J. Thottam
B. Siegel
S. S. Choi
Affiliation(s)
Children's Hospital Of Pittsburgh Of UPMC; Children's Hospital Of Michigan; Wayne State University; Michigan State University; Michigan Pediatric Ear, Nose And Throat Associates
Abstract:
Surveillance bronchoscopy of tracheostomy tube dependent pediatric patients is not standardized, and recommended frequency varies widely. The aim of this study is to evaluate the role of interval bronchoscopy and its association with outcomes in chronic tracheostomy tube dependent pediatric patients. A retrospective cohort of 40 pediatric patients who underwent tracheostomy tube placement between 2002 and 2006 with 12-year follow-up was investigated. Regression analysis and non-parametric methods were used to analyze interval bronchoscopy and outcomes of interest. The most common reasons for tracheostomy tube placement were airway obstruction (62.5%) and chronic respiratory failure (32.5%). The average duration of the tracheostomy tube was 58.4 months (5-151 months). Average time between interval bronchoscopy was 7.2 months (SD 4.9). There was no association between frequency of interval bronchoscopy and hospital admissions, clinic or emergency department visits, accidental decannulation, tracheostomy tube occlusion, adverse respiratory events, or tracheal ulceration (p>0.05). More frequent bronchoscopy was associated with increased rate of obstructive tracheal granulomas (p=0.008). Overall, 22 patients (55%) were successfully decannulated. Median time between bronchoscopy in those who were decannulated was 5 months as compared to 7 months in those who remained tracheostomy tube dependent (p=0.007). Two fatalities occurred and were unrelated to the presence of tracheotomy tube or interval bronchoscopy. While pediatric tracheostomy tubes are associated with high morbidity, the value of routine interval bronchoscopy is unclear and controversial. This study demonstrated an association between frequent bronchoscopy directed airway surveillance and obstructive granulomas, but a higher rate of decannulation. Further investigation is indicated.