title: Tracheostomy Complications in Institutionalized Children with Long-term Tracheostomy and Ventilator Dependence.
abstract: OBJECTIVE
  (1) To identify tracheostomy complications in institutionalized children with chronic tracheostomy. (2) To determine factors that predispose to development of tracheostomy complications in institutionalized children with chronic tracheostomy.
  
  
  METHODS
  Case series with chart review over 10 years.
  
  
  METHODS
  Tertiary children's hospital.
  
  
  METHODS
  Children were included if they underwent tracheostomy before 21 years of age and resided at a pediatric nursing facility. Most children were ventilator dependent and had severe comorbid medical conditions, including developmental delay and cerebral palsy. The number of tracheostomy complications and unplanned hospital admissions were recorded. Interventions for tracheostomy complications were also reviewed.
  
  
  RESULTS
  Thirty-two institutionalized children with chronic tracheostomy were included. The mean age at time of tracheostomy was 5.4 years, with a mean duration of institutionalization of 9.1 years. Twenty-seven children (84%) experienced tracheostomy complications. The total number of complications was 79. The most common tracheostomy complications identified were peristomal granulation (n = 13) and suprastomal granulation (n = 12). Age at time of tracheostomy, duration of institutionalization, and ventilator dependence did not predict the likelihood of developing a complication. Of 32 patients, 20 were evaluated in the emergency room during the study, and there were 48 unplanned admissions for tracheostomy-related complications during the study. Forty-five urgent direct laryngoscopy and bronchoscopy procedures were performed in a total of 20 children with tracheostomy complications.
  
  
  CONCLUSIONS
  Tracheostomy complications are common in institutionalized children with chronic tracheostomy and are challenging to manage. Further research is necessary to determine novel ways to reduce tracheostomy complications in this population.
authors.affiliation: Department of Otolaryngology-Head and Neck Surgery, Eastern Virginia Medical School, Norfolk, Virginia, USA wilcoxlj@evms.edu lyndyjane8@gmail.com.
authors.forename: Lyndy J
authors.initials: LJ
authors.lastname: Wilcox
authors.affiliation: Department of Otolaryngology-Head and Neck Surgery, Eastern Virginia Medical School, Norfolk, Virginia, USA.
authors.forename: Brittany C
authors.initials: BC
authors.lastname: Weber
authors.affiliation: Graduate Program in Public Health, Eastern Virginia Medical School, Norfolk, Virginia, USA.
authors.forename: Tina D
authors.initials: TD
authors.lastname: Cunningham
authors.affiliation: Department of Otolaryngology-Head and Neck Surgery, Eastern Virginia Medical School, Norfolk, Virginia, USA Department of Pediatric Otolaryngology, Children's Hospital of the King's Daughters, Norfolk, Virginia, USA.
authors.forename: Cristina M
authors.initials: CM
authors.lastname: Baldassari
mesh_terms: D000293:Adolescent; D000328:Adult; D001999:Bronchoscopy; D002648:Child; D002673:Child, Hospitalized; D015897:Comorbidity; D005260:Female; D006776:Hospitals, Pediatric; D006801:Humans; D007828:Laryngoscopy; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D012121:Respiration, Artificial / Q000009:adverse effects*; D012189:Retrospective Studies; D014139:Tracheostomy / Q000009:adverse effects*
keywords: airway; complications; management; pediatric; prevention; quality improvement; tracheostomy