(151) Early First Tracheostomy Change in Pediatric Patients Having Fenestrated Tracheostomy

Monday, October 2, 2023

2:45 PM – 3:45 PM East Coast USA Time

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Co-Author(s)

YK

Yuna Kim, MD

Resident physician
University of Nevada School of Medicine (Kirk Kerkorian SOM At UNLV)
Las Vegas , Nevada, United States

Presenting Author(s)

Shannon Calaguas, MD

Resident Physician
Loma Linda University Health, Department of Otolaryngology - Head & Neck Surgery
Loma Linda, California, United States

Co-Author(s)

EF

Ethan D. Frank, MD

Fellow - Pediatric Otolaryngology
Rady Children's Hospital/UC San Diego Department of Otolaryngology
San Diego, CA, United States
GA

Gabriel Arom, MD

Resident Physician
Loma Linda University Health, Department of Otolaryngology - Head & Neck Surgery
Placentia, California, United States
AS

Alycia Spinner, MD

Assistant Professor
University of New Mexico School of Medicine
Albuquerque , New Mexico, United States

Senior Author(s)

TO

T.J. O-Lee, MD

Chief of Pediatric Otolaryngology
Loma Linda University Health, Department of Otolaryngology - Head & Neck Surgery
Loma Linda, California, United States

Disclosure(s):

Shannon Calaguas, MD: No relevant relationships to disclose.

Gabriel Arom, MD: No relevant relationships to disclose.

Alycia Spinner, MD: No relevant relationships to disclose.

T.J. O-Lee, MD: No relevant relationships to disclose.

Introduction: First tracheostomy tube changes are typically performed 5-7 days after surgery to minimize complications such as potential airway loss; however, current literature suggests that earlier first change regimens are both safe and beneficial. This multi-institutional study aims to demonstrate that first tracheostomy change as early as post-operative day 1 is safe without increased morbidity and mortality in pediatric patients having fenestrated tracheostomy.

Methods: Retrospective chart review was performed of pediatric patients who underwent standard (non-matured) tracheostomy or fenestrated tracheostomy at two tertiary children’s hospitals between April 2013 and August 2022. Rates of morbidity and mortality were compared between the two groups.

Results: There were 200 patients in the standard tracheostomy group and 112 in the fenestrated tracheostomy group. The standard tracheostomy group was 37% female and the fenestrated, 46%. Caucasian and African American children comprised the majority of patients, representing 58% and 16.5% in the standard group and 49% and 20% in the fenestrated group. The average ages were 64 months and 54 months in the standard and fenestrated groups, respectively. The rates of accidental decannulation, persistent tracheocutaneous fistula, and death were 22% vs 5% (p < 0.01), 13% vs. 6% (p = 0.06), and 6.5% vs. 1.8% (p < 0.01) in the standard and fenestrated groups. The average time to first trach change was 1.5 days in the fenestrated group and 6.8 days in the standard group (p < 0.01).

Conclusions: Early tracheostomy tube change for pediatric patients having fenestrated tracheostomy is not associated with increased risk of post-operative morbidity or mortality.