Ozgul Gergin1, Eelam Adil2, Kosuke Kawai3, Karen Watters2, Ethan Moritz1, Reza Rahbar4. 1. Department of Otolaryngology and Communication Enhancement, Boston Children's Hospital, Boston, MA, USA. 2. Department of Otolaryngology and Communication Enhancement, Boston Children's Hospital, Boston, MA, USA; Department of Otolaryngology, Harvard Medical School, Boston, MA, USA. 3. Department of Otolaryngology and Communication Enhancement, Boston Children's Hospital, Boston, MA, USA; Clinical Research Center, Boston Children's Hospital, Boston, MA, USA. 4. Department of Otolaryngology and Communication Enhancement, Boston Children's Hospital, Boston, MA, USA; Department of Otolaryngology, Harvard Medical School, Boston, MA, USA. Electronic address: reza.rahbar@childrens.harvard.edu.
Abstract
OBJECTIVES: The aim of this study is to review airway findings in children with tracheostomies who underwent surveillance direct laryngoscopy and bronchoscopy (DLB) to determine the yield of routine airway evaluation in these patients. STUDY DESIGN: Retrospective chart review at tertiary referral children's hospital. METHODS: A retrospective chart review was conducted of all of the children with tracheostomies who underwent DLB after tracheostomy between 1984 and 2015. RESULTS: A total of 303 patients met inclusion criteria. The median time interval between tracheostomy and first follow-up DLB was 12.0 months (IQR 4.8-28.9 months). There was no significant difference in the incidence of airway lesions between patients who underwent endoscopy <6 months post tracheostomy versus those who had a longer time interval between tracheostomy and DLB (p = 0.16). One hundred sixty seven patients (55.1%) were diagnosed with lesions, with suprastomal granulation (39.9%) being the most common. Symptomatic patients were significantly more likely to have an airway lesion identified (69.9% versus 42.0%; p < 0.001). Ventilator dependent patients and those with either cardiopulmonary disease or traumatic injury as indications for tracheostomy were significantly more likely to have an airway lesion (p = 0.01). CONCLUSIONS: The high incidence of airway lesions noted during surveillance DLB support the utility of routine airway endoscopy in pediatric tracheostomy patients. Symptomatic patients, those with ventilator dependence, or cardiopulmonary or trauma indications for tracheostomy are more likely to have airway lesions and should be monitored closely. The ideal time interval between surveillance endoscopies needs to be examined further.
OBJECTIVES: The aim of this study is to review airway findings in children with tracheostomies who underwent surveillance direct laryngoscopy and bronchoscopy (DLB) to determine the yield of routine airway evaluation in these patients. STUDY DESIGN: Retrospective chart review at tertiary referral children's hospital. METHODS: A retrospective chart review was conducted of all of the children with tracheostomies who underwent DLB after tracheostomy between 1984 and 2015. RESULTS: A total of 303 patients met inclusion criteria. The median time interval between tracheostomy and first follow-up DLB was 12.0 months (IQR 4.8-28.9 months). There was no significant difference in the incidence of airway lesions between patients who underwent endoscopy <6 months post tracheostomy versus those who had a longer time interval between tracheostomy and DLB (p = 0.16). One hundred sixty seven patients (55.1%) were diagnosed with lesions, with suprastomal granulation (39.9%) being the most common. Symptomatic patients were significantly more likely to have an airway lesion identified (69.9% versus 42.0%; p < 0.001). Ventilator dependent patients and those with either cardiopulmonary disease or traumatic injury as indications for tracheostomy were significantly more likely to have an airway lesion (p = 0.01). CONCLUSIONS: The high incidence of airway lesions noted during surveillance DLB support the utility of routine airway endoscopy in pediatric tracheostomy patients. Symptomatic patients, those with ventilator dependence, or cardiopulmonary or trauma indications for tracheostomy are more likely to have airway lesions and should be monitored closely. The ideal time interval between surveillance endoscopies needs to be examined further.
Authors: Ha Trang; Martin Samuels; Isabella Ceccherini; Matthias Frerick; Maria Angeles Garcia-Teresa; Jochen Peters; Johannes Schoeber; Marek Migdal; Agneta Markstrom; Giancarlo Ottonello; Raffaele Piumelli; Maria Helena Estevao; Irena Senecic-Cala; Barbara Gnidovec-Strazisar; Andreas Pfleger; Raquel Porto-Abal; Miriam Katz-Salamon Journal: Orphanet J Rare Dis Date: 2020-09-21 Impact factor: 4.123