title: Care of pediatric tracheostomy in the immediate postoperative period and timing of first tube change.
abstract: OBJECTIVE
  To analyze the safety of a standardized pediatric tracheostomy care protocol in the immediate postoperative period and its impact on tracheostomy related complications.
  
  
  METHODS
  Retrospective case series.
  
  
  METHODS
  Pediatric patients undergoing tracheotomy from February 2010-February 2014.
  
  
  METHODS
  In 2012, a standardized protocol was established regarding postoperative pediatric tracheostomy care. This protocol included securing newly placed tracheostomy tubes using a foam strap with hook and loop fastener rather than twill ties, placing a fresh drain sponge around the tracheostomy tube daily, and performing the first tracheostomy tube change on postoperative day 3 or 4. Outcome measures included rate of skin breakdown and presence of a mature stoma allowing for a safe first tracheostomy tube change. Two types of tracheotomy were performed based on patient age: standard pediatric tracheotomy and adult-style tracheotomy with a Bjork flap. Patients were analyzed separately based on age and the type of tracheotomy performed.
  
  
  RESULTS
  Thirty-seven patients in the pre-protocol group and 35 in the post-protocol group were analyzed. The rate of skin breakdown was significantly lower in the post-protocol group (standard: p=0.0048; Bjork flap: p=0.0003). In the post-protocol group, all tube changes were safely accomplished on postoperative day three or four, and the stomas were deemed to be adequately matured to do so in all cases.
  
  
  CONCLUSIONS
  A standardized postoperative pediatric tracheostomy care protocol resulted in decreased rates of skin breakdown and demonstrated that pediatric tracheostomy tubes can be safely changed as early as 3 days postoperatively.
authors.affiliation: University of Wisconsin School of Medicine and Public Health, Division of Otolaryngology-Head and Neck Surgery, 600 Highland Ave, K4/720 Clinical Science Center, Madison, WI 53792, United States.
authors.forename: Dylan
authors.initials: D
authors.lastname: Lippert
authors.affiliation: University of Wisconsin School of Medicine and Public Health, Division of Otolaryngology-Head and Neck Surgery, 600 Highland Ave, K4/720 Clinical Science Center, Madison, WI 53792, United States.
authors.forename: Matthew R
authors.initials: MR
authors.lastname: Hoffman
authors.affiliation: Rush University Medical Center, Department of General Surgery, Chicago, IL, United States.
authors.forename: Phat
authors.initials: P
authors.lastname: Dang
authors.affiliation: University of Wisconsin School of Medicine and Public Health, Division of Otolaryngology-Head and Neck Surgery, 600 Highland Ave, K4/720 Clinical Science Center, Madison, WI 53792, United States.
authors.forename: J Scott
authors.initials: JS
authors.lastname: McMurray
authors.affiliation: University of Wisconsin School of Medicine and Public Health, Division of Otolaryngology-Head and Neck Surgery, 600 Highland Ave, K4/720 Clinical Science Center, Madison, WI 53792, United States.
authors.forename: Diane
authors.initials: D
authors.lastname: Heatley
authors.affiliation: University of Wisconsin School of Medicine and Public Health, Division of Otolaryngology-Head and Neck Surgery, 600 Highland Ave, K4/720 Clinical Science Center, Madison, WI 53792, United States. Electronic address: kille@surgery.wisc.edu.
authors.forename: Tony
authors.initials: T
authors.lastname: Kille
mesh_terms: D002648:Child; D002675:Child, Preschool; D004322:Drainage; D005260:Female; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D007440:Intubation; D008297:Male; D011182:Postoperative Care / Q000009:adverse effects / Q000379:methods*; D012189:Retrospective Studies; D012871:Skin Diseases / Q000209:etiology*; D013524:Surgical Flaps / Q000009:adverse effects; D013997:Time Factors; D014139:Tracheostomy / Q000009:adverse effects; D014140:Tracheotomy / Q000009:adverse effects / Q000379:methods*
keywords: Complications; Pediatric tracheostomy; Skin breakdown; Standardization of care; Tracheostomy tube change