Neurologic Comorbidities and Failure to Thrive Associated with Unsuccessful Decannulation After Pediatric Tracheostomy

What are the factors most significantly associated with successful decannulation and long-term outcomes in children undergoing tracheostomy?

Bottom line: Neurologic comorbidities and failure to thrive (FTT) are risk factors for unsuccessful decannulation after pediatric tracheostomy. Nutritional interventions may help improve post-procedural long-term outcomes.

BACKGROUND: Indications for pediatric tracheostomy include relief of acute upper airway obstruction, long-term ventilation for neuromuscular diseases, congenital anomalies, obstructive sleep apnea, and acquired subglottic stenosis. However, tracheostomy placement is associated with significant morbidity and mortality. Identifying risk factors associated with poor outcomes would improve anticipatory care and treatment of high-risk patients.

STUDY DESIGN: Case series with chart review.

SETTING: KK Women’s and Children’s Hospital, Singapore.

SYNOPSIS: Researchers conducted a retrospective analysis on 105 patients <16 years of age who underwent tracheostomies at one hospital from January 2006 to December 2016. Eighty-one children had a preexisting comorbidity, and 44 had preexisting FTT. Tracheostomy indications were classified as cardiorespiratory, neurologic, and anatomic airway obstruction causes (most common). Researchers defined the primary outcome as successful decannulation and secondary outcomes as mechanical ventilation presence or supplemental oxygen need at discharge, hospital and PICU stay length, speaking valve use, complications, and death. There were 14 deaths, none related to tracheostomy. Out of the 91 surviving patients, 50 had a continual dependence on tracheostomy. Dependence risk factors were the presence of neurologic comorbidities and FTT, which may be due to underlying chronic conditions causing insufficient weight gain but may in itself contribute to an inability to decannulate due to malnutrition. The study suggests that pre- or postoperative nutritional interventions are potential therapies to improve long-term outcomes following pediatric tracheostomies. The study’s limitations included its retrospective design, which pre-empts causal association between identified risk factors and decannulation failure.

CITATION: Chia AZH, Ng ZM, Pang YX, et al. Epidemiology of pediatric tracheostomy and risk factors for poor outcomes: an 11-year single-center experience. Otolaryngol Head Neck Surg. 2020;162:121–128.