Title

Timing the First Pediatric Tracheostomy Tube Change: A Randomized Controlled Trial.

Authors

Stephen R Chorney
Rosemary C Patel, Children's Hospital of Philadelphia, Philadelphia, PAFollow
Allison E Boyd
Joanne Stow, Children's Hospital of Philadelphia, Philadelphia, PAFollow
Mary M Schmitt, Children's Hospital of Philadelphia, Philadelphia, PAFollow
Deborah Lipman, Children's Hospital of Philadelphia, Philadelphia, PAFollow
Julia F Dailey, Children's Hospital of Philadelphia, Philadelphia, PAFollow
Carol Nhan
Terri Giordano, Children's Hospital of Philadelphia, Philadelphia, PAFollow
Steven E Sobol, Children's Hospital of Philadelphia, Philadelphia, PAFollow

Publication Title

Otolaryngology and head and neck surgery

Document Type

Article

PubMed ID

32928049

Abstract

OBJECTIVE: The first pediatric tracheostomy tube change often occurs within 7 days after placement; however, the optimal timing is not known. The primary objective was to determine the rate of adverse events of an early tube change. Secondary objectives compared rates of significant peristomal wounds, sedation requirements, and expedited intensive care discharges.

STUDY DESIGN: Prospective randomized controlled trial.

SETTING: Tertiary children's hospital between October 2018 and April 2020.

METHODS: A randomized controlled trial enrolled children under 24 months to early (day 4) or late (day 7) first tracheostomy tube changes.

RESULTS: Sixteen children were enrolled with 10 randomized to an early change. Median age was 5.9 months (interquartile range, 5.4-8.3), and 86.7% required tracheostomy for respiratory failure. All tracheostomy tube changes were performed without adverse events. There were no accidental decannulations. Significant wounds developed in 10% of children with early tracheostomy tube changes and 83.3% of children with late tracheostomy tube changes (odds ratio [OR], 45.0; 95% CI, 2.3-885.6;

CONCLUSION: The first tracheostomy tube change in children can occur without adverse events on day 4, resulting in fewer significant peristomal wounds and earlier intensive care discharge.

Keywords

Female, Humans, Infant, Male, Postoperative Complications, Prospective Studies, Time Factors, Tracheostomy

DOI

10.1177/0194599820954137

Publication Date

4-1-2021

Citation

Chorney, S., Patel, R., Boyd, A., Stow, J., Schmitt, M., Lipman, D., Dailey, J., Nhan, C., Giordano, T., & Sobol, S. (2021). Timing the First Pediatric Tracheostomy Tube Change: A Randomized Controlled Trial.. Otolaryngology and head and neck surgery, 164 (4), 869-876. https://doi.org/10.1177/0194599820954137