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18216

Outcomes of Tracheostomies In Children with Congenital Heart Disease

Sunday, October 21, 2012
Room 210 (Morial Convention Center)
Geetha Challapudi, MD, Carman and Ann Adams Department of Pediatrics, Children's Hospital of Michigan, Wayne State University School of Medicine, Detroit, MI, Girija Natarajan, MD, The Carman and Ann Adams Department of Pediatrics, Division of Neonatal-Perinatal Medicine, Children's Hospital of Michigan, Detroit, MI and Sanjeev Aggarwal, MD, Division of Cardiology, Carman and Ann Adams Department of Pediatrics, Children's Hospital of Michigan, Wayne State University School of Medicine, Detroit, MI

Purpose: A subset of children with repaired congenital heart disease (CHD) may require tracheotomy for ongoing ventilatory support. Data on outcomes in this population are scarce. Our objectives were to describe indications for and short-term outcomes related to tracheotomy in children with repaired CHD.  

Methods: A retrospective chart review of children with repaired CHD who underwent tracheotomy at a single center over a 10 year period. Exclusion criteria were prematurity, isolated PDA ligation and neuromuscular conditions. Follow-up outcomes and all readmissions after the initial discharge were reviewed.

Results: A total of 21 subjects with CHD underwent tracheotomy at a median (range) age of 4 months (1 month-7 years) and mean (SD) weight of 7.2 (5.9) kg. Table 1 describes the demographics and clinical data of the subjects. The most common indication for tracheotomy was tracheomalacia or ventilator-dependence in 19 (90.5%) subjects, followed by vocal cord palsy and thoracic insufficiency in 1 (4.7%) each. The mean post-tracheotomy length of stay was 55 (35) days. Of the 19 infants who survived to discharge, 17 (81%) were on home ventilation. A total of 11 (52%) subjects died, all were mechanically ventilated. Table 2 describes follow-up data after tracheotomy. Three children underwent successful decannulation of tracheotomy. The number of readmissions decreased from 2.4 /year in the 1st year to 1.6 /year in the 2nd year to 1.7/year in the 3rd year. The total duration of hospitalization after first discharge decreased from 15.5 days/patient-year in the first year to 7 days/patient-year in the 2nd yr after discharge following tracheotomy.

Table 1: Demographic and clinical data

Tracheostomy

N(%) or mean ± SD

Age at cardiac surgery

3weeks (1 week to 7 yrs)

Male Gender   

11 (52.4)

Primary cardiac lesion

 

     VSD/COA

2

     AV canal

4

     VSD/ASD

2

     AP window and interrupted aortic arch

1

     DORV

2

     PA/VSD/TOF

3

    Truncus

3

    Ebstein

1

    OHT

3

Syndromes

 

            Down syndrome

4

            Charge syndrome

2

            Digeorge syndrome

3

            Myopathies

1

            Other genetic

4

            Ellis Van Crevald syndrome

1

 

Table 2: Follow up Data

Reasons for readmissions (n=51) in first year

 

          Respiratory/Pneumonia

27

          Tracheostomy obstruction/dislodge

8

          Tracheostomy bleed

2

          sepsis

1

          Infective/ other

13

Number of admission (pts)

 

            No readmission

5

            <5 first year

10

            >5 first year

4

Died

11

Died within first hospitalization

2

Died within 6 months

5

Died after 6 months

4

Cause of death

            Sepsis

            Respiratory Failure

            Cardiac arrest

3

2

6

Conclusions: The overwhelming majority of children with CHD who needed tracheotomy did so for ventilator dependence and tracheomalacia and had coexisting genetic syndromes. About half the cohort died; among survivors, readmissions were common but decreased after the first year. These results underscore the ongoing mortality and morbidity risks faced by this vulnerable population.