ENTtoday
  • Home
  • COVID-19
  • Practice Focus
    • Allergy
    • Facial Plastic/Reconstructive
    • Head and Neck
    • Laryngology
    • Otology/Neurotology
    • Pediatric
    • Rhinology
    • Sleep Medicine
  • Departments
    • Issue Archive
    • TRIO Best Practices
      • Allergy
      • Facial Plastic/Reconstructive
      • Head and Neck
      • Laryngology
      • Otology/Neurotology
      • Pediatric
      • Rhinology
      • Sleep Medicine
    • Career Development
    • Case of the Month
    • Everyday Ethics
    • Health Policy
    • Legal Matters
    • Letter From the Editor
    • Medical Education
    • Online Exclusives
    • Practice Management
    • Resident Focus
    • Rx: Wellness
    • Special Reports
    • Tech Talk
    • Viewpoint
    • What’s Your O.R. Playlist?
  • Literature Reviews
    • Allergy
    • Facial Plastic/Reconstructive
    • Head and Neck
    • Laryngology
    • Otology/Neurotology
    • Pediatric
    • Rhinology
    • Sleep Medicine
  • Events
    • Featured Events
    • TRIO Meetings
  • Contact Us
    • About Us
    • Editorial Board
    • Triological Society
    • Advertising Staff
    • Subscribe
  • Advertise
    • Place an Ad
    • Classifieds
    • Rate Card
  • Search

What Is the Best Approach to Prevent Advanced-Stage Pressure Injuries After Pediatric Tracheotomy?

by Christopher B. Sullivan, MD, Michael D. Puricelli, MD, and Richard J. Smith, MD • June 16, 2021

  • Tweet
  • Email
Print-Friendly Version

TRIO Best PracticeTRIO Best Practice articles are brief, structured reviews designed to provide the busy clinician with a handy outline and reference for day-to-day clinical decision making. The ENTtoday summaries below include the Background and Best Practice sections of the original article. To view the complete Laryngoscope articles free of charge, visit Laryngoscope.

You Might Also Like

No related posts.

Explore This Issue
June 2021

BACKGROUND

Pediatric tracheotomy is performed over 4,800 times annually (Laryngoscope. 2013;123:3201-3205). A spectrum of postoperative complications occur from 36% to 60% of the time, including hospital-acquired pressure injuries (PIs) (JAMA Otolaryngol Neck Surg. 2016;142:241-246). PIs result in damage to the specific skin subsite and underlying connective tissue, and are often associated with a medical device (Adv Skin Wound Care. 2020;33:36-42). Among the adult and pediatric population, PIs incur over $9 billion in expenses to the healthcare system annually (ibid.). A PI affects the peristomal skin in the early postoperative period and arises as a result of frictional forces generated by the tracheotomy tube, direct pressure from the tube, and the suture-and-strap techniques used to secure a tube in place, among many other factors (Pediatrics. 2012;129:e792-e797). There is currently no standardized and comprehensive reporting system among otolaryngologists for complications after pediatric tracheotomy, so the resultant morbidity is likely underreported. An improved understanding of the pathogenesis of PIs and the development of management protocols for pediatric tracheotomies could significantly reduce morbidity in tracheotomized children and decrease healthcare costs.

PIs range from minor skin breakdown to more advanced-stage injury, with a stage 3 PI signifying full thickness skin loss with exposure of subcutaneous adipose tissue and a stage 4 PI denoting the additional exposure of tendon, fascia, muscle, bone, or cartilage. The National Quality Forum, a nonprofit organization that promotes patient safety, designates advanced-stage (3 and 4) PIs as never events or adverse events that should never occur, and has recommended mandatory reporting that has been adopted in various forms by over 26 states and the District of Columbia. As healthcare payers incentivize patient safety, PIs could significantly affect hospital reimbursement.

Although minor skin irritation and early stage (1 and 2) PIs might not be fully preventable due to a multitude of factors, advanced-stage PIs can mostly be avoided with meticulous perioperative care. In this best practice review, we provide recommendations for peristomal wound management to prevent advanced-stage PIs after a pediatric tracheotomy.

BEST PRACTICE

An array of complications may arise after a pediatric tracheotomy, and the clinician should be mindful of advanced-stage PI. Although minor skin breakdown might occur, advanced-stage PIs should rarely develop. We recommend considering placement of an extended tracheotomy tube when individual patient head and neck anatomy permits and when available at the time of surgery. A foam pad should also be placed between the tracheotomy tube flanges and peristomal skin to control the amount of moisture in the wound bed and to redistribute the weight of the tracheotomy tube and ventilatory circuit (Table I). These preventative measures can also be employed in patients with mature stomas if there is concern for skin breakdown. It should be recognized, however, that due to the delicate nature of pediatric skin and other potential factors, including paralysis and immobilization, minor PIs may still occur.

Pages: 1 2 | Single Page

Filed Under: Pediatric, Pediatric, TRIO Best Practices Tagged With: pediatric, TracheotomyIssue: June 2021

You Might Also Like:

The Triological SocietyENTtoday is a publication of The Triological Society.

The Laryngoscope
Ensure you have all the latest research at your fingertips; Subscribe to The Laryngoscope today!

Laryngoscope Investigative Otolaryngology
Open access journal in otolaryngology – head and neck surgery is currently accepting submissions.

Classifieds

View the classified ads »

TRIO Best Practices

View the TRIO Best Practices »

Top Articles for Residents

  • Do Training Programs Give Otolaryngology Residents the Necessary Tools to Do Productive Research?
  • Why More MDs, Medical Residents Are Choosing to Pursue Additional Academic Degrees
  • What Physicians Need to Know about Investing Before Hiring a Financial Advisor
  • Tips to Help You Regain Your Sense of Self
  • Should USMLE Step 1 Change from Numeric Score to Pass/Fail?
  • Popular this Week
  • Most Popular
  • Most Recent
    • Some Studies Predict a Shortage of Otolaryngologists. Do the Numbers Support Them?
    • The Dramatic Rise in Tongue Tie and Lip Tie Treatment
    • Vertigo in the Elderly: What Does It Mean?
    • Neurogenic Cough Is Often a Diagnosis of Exclusion
    • Complications for When Physicians Change a Maiden Name
    • Vertigo in the Elderly: What Does It Mean?
    • New Developments in the Management of Eustachian Tube Dysfunction
    • Some Laryngopharyngeal Reflux Resists PPI Treatment
    • The Dramatic Rise in Tongue Tie and Lip Tie Treatment
    • Eustachian Tuboplasty: A Potential New Option for Chronic Tube Dysfunction and Patulous Disease
    • Tympanoplasty Tips: Otology Experts Give Advice on the Procedure
    • How Treatment for Obstructive Sleep Apnea (OSA) Is Evolving to Give Patients a Better Night’s Sleep
    • Vestibular Schwannoma Position Relative to Internal Auditory Canal Helps Predict Postoperative Facial Function
    • Vocal Fold Lipoaugmentation Provides Long-Term Voice Improvements for Glottal Insufficiency
    • Upper Lateral Cartilage Mucosal Flap Enables the Successful Closure of Larger Septal Perforations

Polls

Do you think there will be a shortage of otolaryngologists in the next five to 10 years?

View Results

Loading ... Loading ...
  • Polls Archive
  • Home
  • Contact Us
  • Advertise
  • Privacy Policy
  • Terms of Use

Visit: The Triological Society • The Laryngoscope • Laryngoscope Investigative Otolaryngology

Wiley
© 2022 The Triological Society. All Rights Reserved.
ISSN 1559-4939

loading Cancel
Post was not sent - check your email addresses!
Email check failed, please try again
Sorry, your blog cannot share posts by email.