title: Natural course following pediatric tracheostomy.
abstract: OBJECTIVE
  To describe the hospital course of pediatric posttracheostomy patients, their underlying diagnosis, and their demographic characteristics.
  
  
  METHODS
  Retrospective, descriptive record review.
  
  
  METHODS
  Academic tertiary Pediatric Critical Care Unit.
  
  
  RESULTS
  One hundred and forty-one patients 1 month to 20 years old identified and included in the study. The length of in-hospital stay ranged from 14 to 280 days. The most common indications for tracheostomy were ventilation of chronic lung disease (CLD), subglottic stenosis, or combination at 44.7% of the cases followed by neurological cases 26.2%. Patients requiring prolonged stay were more likely to have pulmonary hypertension (odds ratio [OR] = 5.43), gastrointestinal reflux (OR = 2.09), prior episodes of failure to thrive (OR = 4.17), feeding failure requiring feeding tube (OR = 3.32), and tracheitis (OR = 4.17). The chances for home ventilation requirement increased with long preoperative in-hospital ventilation time and high ventilator respiratory rate on the day of tracheostomy as 0.98 days for each preoperative day and 0.94 days for each set ventilator breath (set respiratory rate per minute). The survival rate was 98.9% for the first 30 days and 78% afterward.
  
  
  CONCLUSIONS
  Chronic lung disease, subglottic stenosis, and combinations are the most common causes for tracheostomy at present followed for tracheostomy due to neurological problems. Children requiring tracheostomy have lengthy hospital stay. Establishing an accurate diagnosis helps predict the length of hospitalization and the need for home ventilation; however, in less clear cases, the length of stay can be predicted from the presence of pulmonary hypertension, reflux, and failure to thrive. The mortality rate is low at the postoperative period and increases depending upon the underline reason for tracheostomy referral.
authors.affiliation: Division of Critical Care Medicine, Department of Pediatrics, University of Tennessee, TN, USA. tspentza@utmem.edu
authors.forename: Tom
authors.initials: T
authors.lastname: Spentzas
authors.forename: Michael
authors.initials: M
authors.lastname: Auth
authors.forename: Patricia
authors.initials: P
authors.lastname: Hess
authors.forename: Milan
authors.initials: M
authors.lastname: Minarik
authors.forename: Stephanie
authors.initials: S
authors.lastname: Storgion
authors.forename: Gregory
authors.initials: G
authors.lastname: Stidham
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D006701:Home Nursing; D006776:Hospitals, Pediatric; D006801:Humans; D007223:Infant; D007829:Laryngostenosis / Q000628:therapy; D007902:Length of Stay; D055370:Lung Injury / Q000628:therapy; D012372:ROC Curve; D012121:Respiration, Artificial; D012131:Respiratory Insufficiency / Q000628:therapy; D012189:Retrospective Studies; D013714:Tennessee; D014139:Tracheostomy; D016896:Treatment Outcome; D055815:Young Adult