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. 2021 May 4:9:661512.
doi: 10.3389/fped.2021.661512. eCollection 2021.

Mortality and Outcomes of Pediatric Tracheostomy Dependent Patients

Kiran B Hebbar  1 , Ajay S Kasi  2 , Monica Vielkind  1 , Courtney E McCracken  3 , Caroline C Ivie  2 , Kara K Prickett  4 , Dawn M Simon  2
Affiliations

Mortality and Outcomes of Pediatric Tracheostomy Dependent Patients

Kiran B Hebbar et al. Front Pediatr. .

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.

Keywords: decannulation; mortality; outcome; pediatric; tracheostomy.

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Conflict of interest statement

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Figures

Figure 1
Figure 1
Overall survival estimates of the entire cohort. KM Est, Kaplan-Meier survival estimates; CI, confidence interval.
Figure 2
Figure 2
Survival estimates based on the indication for tracheostomy.
Figure 3
Figure 3
Time from tracheostomy to decannulation for the entire cohort. CIF Est, Cumulative incidence function estimates; CI, confidence interval.
Figure 4
Figure 4
Decannulation based on indication for tracheostomy. Decannulation rates based on tracheostomy indication: airway obstruction (18/59, 31%), pulmonary (13/66, 20%), and neurologic (5/39,13%). Trach, Tracheostomy.
See this image and copyright information in PMC

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