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Pediatric tracheocutaneous fistula closure following tracheostomy decannulation.
Int J Pediatr Otorhinolaryngol 2019; 125:122-127IJ

Abstract

OBJECTIVE

To determine the frequency and risk factors that lead to the development of persistent TCF (tracheocutaneous fistula) formation in children following tracheostomy decannulation at our institution.

METHODS

A retrospective chart review of all pediatric patients at Children's Hospital Colorado who underwent tracheostomy decannulation and were being followed between January 1, 2007 and December 31, 2013. TCF was defined as a persistent fistula six months following decannulation. We determined patient demographics, age at tracheotomy, primary indication for tracheotomy, tracheostomy-tube size, medical comorbidities, age at decannulation, date of TCF closure, and method of TCF closure.

RESULTS

One hundred twenty-nine patients ranging from 51 days to 19 years of age underwent tracheostomy decannulation. 63 (49%) patients underwent surgical closure of TCF. Compared to those with spontaneous closure by multivariable analysis, those with surgical closure were younger at tracheostomy placement (p = 0.0002), had a tracheostomy for a longer duration (p = 0.0025), and were diagnosed with tracheobronchomalacia (p = 0.0051). The likelihood of spontaneous closure decreased over time. Tracheostomy tube internal diameter correlated with age (R = 0.64, p < 0.0001).

CONCLUSIONS

Approximately 50% of pediatric tracheostomy stoma sites will close spontaneously. Development of a persistent TCF was associated with younger age at placement, longer duration of tracheostomy, and the presence of tracheobronchomalacia. These observations may help clinicians anticipate outcomes following tracheostomy decannulation in children.

Authors+Show Affiliations

Department of Pediatrics, Section of Pulmonary Medicine, The Ohio State University College of Medicine, Nationwide Children's Hospital, Columbus, Ohio, USA.Department of Otolaryngology, University of Colorado School of Medicine and Children's Hospital Colorado, Aurora, CO, USA.Department of Otolaryngology, University of Colorado School of Medicine and Children's Hospital Colorado, Aurora, CO, USA.Department of Otolaryngology, University of Colorado School of Medicine and Children's Hospital Colorado, Aurora, CO, USA.Department of Pediatrics, Section of Pulmonary Medicine, University of Colorado School of Medicine, Aurora, CO, USA. Electronic address: christopher.baker@ucdenver.edu.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

31299421

Citation

Wisniewski, Benjamin L., et al. "Pediatric Tracheocutaneous Fistula Closure Following Tracheostomy Decannulation." International Journal of Pediatric Otorhinolaryngology, vol. 125, 2019, pp. 122-127.
Wisniewski BL, Jensen EL, Prager JD, et al. Pediatric tracheocutaneous fistula closure following tracheostomy decannulation. Int J Pediatr Otorhinolaryngol. 2019;125:122-127.
Wisniewski, B. L., Jensen, E. L., Prager, J. D., Wine, T. M., & Baker, C. D. (2019). Pediatric tracheocutaneous fistula closure following tracheostomy decannulation. International Journal of Pediatric Otorhinolaryngology, 125, pp. 122-127. doi:10.1016/j.ijporl.2019.07.001.
Wisniewski BL, et al. Pediatric Tracheocutaneous Fistula Closure Following Tracheostomy Decannulation. Int J Pediatr Otorhinolaryngol. 2019;125:122-127. PubMed PMID: 31299421.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Pediatric tracheocutaneous fistula closure following tracheostomy decannulation. AU - Wisniewski,Benjamin L, AU - Jensen,Emily L, AU - Prager,Jeremy D, AU - Wine,Todd M, AU - Baker,Christopher D, Y1 - 2019/07/04/ PY - 2019/05/21/received PY - 2019/07/01/revised PY - 2019/07/02/accepted PY - 2019/7/13/pubmed PY - 2019/7/13/medline PY - 2019/7/13/entrez KW - Decannulation KW - Tracheocutaneous fistula KW - Tracheomalacia KW - Tracheostomy SP - 122 EP - 127 JF - International journal of pediatric otorhinolaryngology JO - Int. J. Pediatr. Otorhinolaryngol. VL - 125 N2 - OBJECTIVE: To determine the frequency and risk factors that lead to the development of persistent TCF (tracheocutaneous fistula) formation in children following tracheostomy decannulation at our institution. METHODS: A retrospective chart review of all pediatric patients at Children's Hospital Colorado who underwent tracheostomy decannulation and were being followed between January 1, 2007 and December 31, 2013. TCF was defined as a persistent fistula six months following decannulation. We determined patient demographics, age at tracheotomy, primary indication for tracheotomy, tracheostomy-tube size, medical comorbidities, age at decannulation, date of TCF closure, and method of TCF closure. RESULTS: One hundred twenty-nine patients ranging from 51 days to 19 years of age underwent tracheostomy decannulation. 63 (49%) patients underwent surgical closure of TCF. Compared to those with spontaneous closure by multivariable analysis, those with surgical closure were younger at tracheostomy placement (p = 0.0002), had a tracheostomy for a longer duration (p = 0.0025), and were diagnosed with tracheobronchomalacia (p = 0.0051). The likelihood of spontaneous closure decreased over time. Tracheostomy tube internal diameter correlated with age (R = 0.64, p < 0.0001). CONCLUSIONS: Approximately 50% of pediatric tracheostomy stoma sites will close spontaneously. Development of a persistent TCF was associated with younger age at placement, longer duration of tracheostomy, and the presence of tracheobronchomalacia. These observations may help clinicians anticipate outcomes following tracheostomy decannulation in children. SN - 1872-8464 UR - https://www.unboundmedicine.com/medline/citation/31299421/Pediatric_tracheocutaneous_fistula_closure_following_tracheostomy_decannulation L2 - https://linkinghub.elsevier.com/retrieve/pii/S0165-5876(19)30310-6 DB - PRIME DP - Unbound Medicine ER -