National Variation in the Use of Tracheostomy in Patients With Congenital Heart Disease*
We describe multicenter variation in the use of tracheostomy in children undergoing congenital heart surgery. Design: We retrospectively analyzed a multicenter cohort. Setting: Pediatric Health Information Systems database retrospective cohort. Patients: Children less than 18 years who underwent both tracheostomy and cardiac surgery (1/04–6/14). Interventions: Univariate and multivariate statistics were performed, stratifying by high (≥ 75th percentile) and low (≤ 25th percentile) tracheostomy volume and adjusting for patient characteristics in multivariate models. Measurements and Main Results: Out of 123,510 hospitalizations involving cardiac surgery, 1,292 tracheostomies (1.2%) were performed (46 hospitals). The rate of tracheostomy placement ranged from 0.3% to 2.5% with no difference in the rate of tracheostomy placement between high and low tracheostomy use centers (p = 0.8). The median time to tracheostomy was 63 days (interquartile range, 36–100), and there was no difference between high- and low-tracheostomy centers. High-tracheostomy centers had $420,000 lower hospital charges than low-volume centers (p = 0.03). Tracheostomy day greater than the median (63 d), Risk Adjustment for Congenital Heart Surgery-1 score 6, and extracorporeal membrane oxygenation were significantly associated with adjusted increased odds of mortality. Later hospital day of tracheostomy was associated with a $13,000/d increase in total hospital charges (p
Authors: AlOtair HA, Alzeer AH, Abdou MA, Qasrawi SO Abstract Central alveolar hypoventilation is rarely encountered. This case report describes a young woman who was recently diagnosed with hypertension and ischemic heart disease. She presented to the emergency room with hypercapnic respiratory failure, for which she was mechanically ventilated. This was preceded by an acute upper respiratory tract infection. She was initially suspected to have Guillain-Barré syndrome, but further investigations ruled out neuromuscular or autoimmune disorders. Sleep-related hypoventilation was suspected after she experience...
Conclusion: Unlike congenital SGS, acquired SGS typically does not improve spontaneously over time and requires intervention. In children with stridor bronchopulmonary dysplasia and congenital heart disease are underlying causes of SGS due to history of intubation. While determining cause of stridor, pediatricians should get information about history of intubation, prematurity and other congenital anomalies and hospitalization due to respiratory problems.
Conclusions:The median score for cognitive, language, and motor scores for preterm infants with neonatal OSA were within one standard deviation of the published norm. Mean end-tidal CO2, independent of AHI, may serve as a biomarker for predicting poor cognitive outcome in preterm infants with neonatal OSA.Commentary:A commentary on this article appears in this issue on page 1233.Citation:Bandyopadhyay A, Harmon H, Slaven JE, Daftary AS. Neurodevelopmental outcomes at two years of age for premature infants diagnosed with neonatal obstructive sleep apnea.J Clin Sleep Med. 2017;13(11):1311–1317.
Conclusions Several risk factors were identified in infants with HLHS in whom a tracheostomy was placed during their first hospitalization. Despite an overall increase in rates of tracheostomies during the study period, the mortality rate did not improve among these patients. Appropriate family counseling and thorough preoperative case selection is suggested when discussing possible tracheostomy placement in infants with HLHS.
Comorbidities are common and can be negative prognostic factors for children undergoing heart transplant (OHT). Tracheostomy is associated with greater resource utilization and mortality in children with congenital heart disease (CHD). However, the prevalence and impact of pre- (PreTT) and post- (PostTT) transplant tracheostomy in pediatric OHT is not known. The aim of this study is to test the hypothesis that tracheostomy is associated with increased resource utilization and mortality in children with OHT.
Authors: Tsukamoto M, Hitosugi T, Esaki K, Yokoyama T Abstract Emanuel syndrome is associated with supernumerary chromosome, which consists of the extra genetic material from chromosome 11 and 22. The frequency of this syndrome has been reported as 1 in 110,000. It is a rare anomaly associated with multiple systemic malformations such as micrognathia and congenital heart disease. In addition, patients with Emanuel syndrome may have seizure disorders. We experienced anesthetic management of a patient with Emanuel syndrome who underwent palatoplasty. This patient had received tracheotomy due to micrognathia. In addit...
Conclusion: BCPAP is well tolerated in critical infants on IMV and can reduce the duration of ventilation weaning process and ICU stay, without severe complications.
Objectives/HypothesisTo assess the longitudinal risk of death following tracheostomy in the pediatric age group. Study DesignRetrospective cohort study. MethodsHospital records of 513 children (≤18 years) at a tertiary care children's hospital who underwent tracheostomy between 1984 and 2015 were reviewed. The primary outcome measure was time from tracheostomy to death. Secondary patient demographic and clinical characteristics were assessed, with likelihood of death using χ2 tests and the Cox proportional hazards model. ResultsMedian age at time of tracheostomy was 0.8 years (interquartile range, 0.3–5.2 year...
Conclusions: Postoperative management of patients with TOF and MAPCA has great significance. To reduce the morbidity and mortality, transcatheter coil embolization or surgical ligation should be performed in patients with a collateral diameter-to-body weight ratio of at least 0.500 mm/kg. In patients with values between approximately 0.200 and 0.500 mm/kg, prolongation of mechanical ventilation should have priority over transcatheter occlusion, and for patients with values below 0.200 mm/kg no additional treatment is needed.Cardiology 2016;134:406-410
Conclusions Tracheostomy as an adverse event of operations for congenital heart disease remains rare but has been increasingly used over the past 15 years. This trend and the considerable mortality risk among patients requiring postoperative tracheostomy support the need for further research in this complex population.