title: A decade of pediatric tracheostomies: Indications, outcomes, and long-term prognosis.
abstract: To define the mortality and long-term outcomes of children undergoing tracheostomy.
  
  
  
  Retrospective chart and Texas Department of Health Bureau of Vital Statistics review of patients admitted to a Pediatric Intensive Care Unit who underwent a tracheostomy between 2001 and 2011. Mortality and decannulation rates were compared based on tracheostomy indication and age.
  
  
  
  A total of 426 patients admitted to a Pediatric Intensive Care Unit in a large tertiary children's hospital.
  
  
  
  The median patient age was 1.5 years (3 days-24 years). Primary indications for tracheostomy included (a) airway obstruction, (b) congenital neurologic disease, (c) acquired neurologic disease, (d) congenital respiratory disease, and (e) acquired respiratory disease. Overall, 98 patients (23%) died during the study period, and 75th percentile survival time was 5.9 years (95%CI: 3-8). Patients undergoing a tracheostomy for airway obstruction were the least likely to die; while patients with acquired neurologic disease were most likely to die. A total of 163 patients (38%) were decannulated, and 50% were decannulated at 1.2 years (95%CI: 0.9-1.5). Patients with congenital neurologic disease were the least likely to undergo decannulation. Over half of the patients were discharged from the hospital requiring some form of mechanical respiratory support in addition to their tracheostomy.
  
  
  
  In this largest cohort of long-term follow-up to date, we have shown the overall risk of mortality varied according to the indication for the tracheostomy. We were unable to determine exact causes of death. The likelihood of being decannulated also correlates with the underlying indication for the tracheostomy. Pediatr Pulmonol. 2017; 52:946-953. © 2017 Wiley Periodicals, Inc.
authors.affiliation: Department of Pediatrics, Baylor College of Medicine, Texas Children's Hospital, Section of Critical Care Medicine, Fannin 6621, WT 6-006, Houston 77030, Texas.
authors.forename: Mona L
authors.initials: ML
authors.lastname: McPherson
authors.affiliation: Department of Pediatrics, Baylor College of Medicine, Texas Children's Hospital, Section of Critical Care Medicine, Fannin 6621, WT 6-006, Houston 77030, Texas.
authors.forename: Lara
authors.initials: L
authors.lastname: Shekerdemian
authors.affiliation: Department of Pediatrics, Baylor College of Medicine, Texas Children's Hospital, Section of Critical Care Medicine, Fannin 6621, WT 6-006, Houston 77030, Texas.
authors.forename: Michelle
authors.initials: M
authors.lastname: Goldsworthy
authors.affiliation: Baylor College of Medicine, Dan L. Duncan Institute for Clinical and Translation Research, Houston, Texas.
authors.forename: Charles G
authors.initials: CG
authors.lastname: Minard
authors.affiliation: Department of Pediatrics, Baylor College of Medicine, Texas Children's Hospital, Section of Critical Care Medicine, Fannin 6621, WT 6-006, Houston 77030, Texas.
authors.forename: Cynthia S
authors.initials: CS
authors.lastname: Nelson
authors.affiliation: Department of Pediatrics, Baylor College of Medicine, Texas Children's Hospital, Section of Critical Care Medicine, Fannin 6621, WT 6-006, Houston 77030, Texas.
authors.forename: Fernando
authors.initials: F
authors.lastname: Stein
authors.affiliation: Department of Pediatrics, Baylor College of Medicine, Texas Children's Hospital, Section of Critical Care Medicine, Fannin 6621, WT 6-006, Houston 77030, Texas.
authors.forename: Jeanine M
authors.initials: JM
authors.lastname: Graf
mesh_terms: D000293:Adolescent; D000328:Adult; D002648:Child; D002675:Child, Preschool; D020878:Device Removal; D005260:Female; D006760:Hospitalization; D006776:Hospitals, Pediatric / Q000706:statistics & numerical data; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D015278:Intensive Care Units, Pediatric / Q000706:statistics & numerical data; D008297:Male; D009422:Nervous System Diseases / Q000601:surgery; D011379:Prognosis; D012140:Respiratory Tract Diseases / Q000601:surgery; D012189:Retrospective Studies; D062606:Tertiary Care Centers / Q000706:statistics & numerical data; D014139:Tracheostomy / Q000401:mortality*; D055815:Young Adult
keywords: decannulation; mortality; outcomes; pediatric; technology-dependent; tracheostomy