Surveillance endoscopy after tracheostomy placement in children: Findings and interventions

Abstract

Objectives/hypothesis: The Seattle Children's Hospital implemented the Trach Safe Initiative to improve airway safety in tracheostomy-dependent children (TDC). A key tenet of this initiative is surveillance endoscopy. The objectives of this study were to describe the prevalence of abnormal airway changes in TDC, identify risk factors for these changes, and describe the frequency of airway interventions.

Study design: Retrospective case series.

Methods: This is a review of children 0 to 21 years old who underwent tracheostomy and surveillance endoscopy from February 1, 2014 to January 1, 2019. Descriptive statistics were used to report the prevalence of abnormal airway changes and interventions following tracheostomy. Pearson χ² tests and logistic regression were used to identify risk factors for the development of abnormal changes.

Results: There were 127 children identified. The median time from tracheostomy to initial surveillance endoscopy was 1.6 months (interquartile range = 1.3-2.4 months). At initial endoscopy, 86.6% of patients had at least one abnormal airway finding. The most common findings were subglottic edema/stenosis (57.3%), glottic edema (37.3%), and suprastomal granulation tissue (31.8%). Prematurity and a history of failed extubations were significantly associated with abnormal findings on endoscopy (odds ratio [OR] = 7.2, P = .01 and OR = 4.1, P = .03, respectively). Of those with abnormal findings, 32.7% underwent an intervention to improve airway patency and safety. The most common interventions performed were suprastomal granuloma excision (44.4%), steroid injection (22.2%), and balloon dilation of the glottis or subglottis (19.4%).

Conclusions: The prevalence of early abnormal airway changes in TDC is high, particularly in young children with a history of prematurity and failed extubation.

Level of evidence: 4 Laryngoscope, 130:1327-1332, 2020.

Keywords: Pediatric tracheostomy; airway obstruction; endoscopy; surveillance; tracheostomy.