10 Year Review of Paediatric Tracheostomies

1. The Leeds Teaching Hospitals NHS Trust 10 Year Review of Paediatric Tracheostomies "Infants and Children who have a Tracheostomy"

2. Changing times • Changing indications for tracheostomy • Fewer short-term tracheostomies • Most for chronic problems leading to tracheostomy use for months or years

3. Parental competency in tracheostomy management • 2 carers trained • Gain competencies in: • Suctioning tube • Changing tapes • Changing tubes • Coping with emergencies • Tube obstruction • Tube dislodgement • Basic paediatric life support

4. Study Objectives • To review indications and length of hospital stay in children undergoing tracheostomy • To highlight reasons for prolonged hospitalisation once medically fit • Identify impediments to timely discharge

5. Methods • 10 year retrospective study 2000 – 2010 • All children undergoing tracheostomy in LTH • Mr Knight, Mr Crabbe • Identified using theatre database • Case notes reviewed

6. Data collected • Demographics • Indication for tracheostomy • Length of hospital stay • Reasons for extended stay • Destination on discharge • Mortality

7. Results • 109 children identified • 101 notes reviewed • Age range 0-15 years • ENT - Mr Knight – 47 • Paed Surgery - Mr Crabbe – 45 • Other - 9

8. Age distribution No of children

9. Age distribution (<18 months)

10. Age distribution (<18 months) 40%

11. Indications To facilitate artificial ventilation To relieve upper airway obstruction

12. Indications To facilitate artificial ventilation To relieve upper airway obstruction Bypass blockage or narrowing in upper airway • Weaning from ventilator • Needs prolonged ventilation • Needs regular pulmonary toilet

13. Indications

14. Indications for tracheostomy

15. Indications for tracheostomy

16. Indications for tracheostomy

17. Indications for tracheostomy

18. Indications for tracheostomy

19. Indications for tracheostomy

20. Indications for tracheostomy

21. Indication vs. Age

22. Indication vs. Age

23. Indication vs. Age

24. Mortality

25. Mortality

26. Time in hospital after tracheostomy Mean 81 days Range 1 – 603 days

27. Time in hospital after “medically fit” • Mean: 19 days • Range: 0 – 265 days

28. Time in hospital after “medically fit” Time (days)

29. Time in hospital after “medically fit” 56 children delayed Time (days)

30. Time in hospital after “medically fit” 56 children delayed 23% for > 1 month Time (days)

31. Time in hospital after “medically fit” 56 children delayed 23% for > 1 month Time (days)

32. Less than 2 weeks • 2 to 4 weeks • 4 to 8 weeks • 8 to 12 weeks • More than 12 weeks

33. Up to 2 weeks - 20

34. Up to 2 weeks - 20

35. Up to 2 weeks - 20

36. Up to 2 weeks - 20

37. Up to 2 weeks - 20

38. Up to 2 weeks - 20

39. Up to 2 weeks - 20

40. Up to 2 weeks - 20

41. 2 to 4 weeks - 13

42. 2 to 4 weeks - 13

43. 2 to 4 weeks - 13

44. 2 to 4 weeks - 13

45. 2 to 4 weeks - 13

46. 2 to 4 weeks - 13

47. 4 to 8 weeks - 14

48. 4 to 8 weeks - 14

49. 4 to 8 weeks - 14

50. 4 to 8 weeks - 14