SESSION TYPE: Pediatric Critical Care
PRESENTED ON: Sunday, October 21, 2012 at 01:15 PM - 02:45 PM
PURPOSE: The presence of a tracheostomy tube provides a direct portal to intrathoracic airways and contributes to almost universal central airway colonization. When these organisms overcome the lung defense mechanisms, tracheobronchitis and/or pneumonia may result. The purpose of this study was to document the incidence, management and outcome of tracheobronchitis in this home bound population.
METHODS: A prospective observational study was conducted in a predominantly pediatric population of tracheostomised patients followed thru a pediatric home care company. Tracheobronchitis(TBS) was defined as a new or altered chronic antibiotic prescription to treat acute respiratory symptoms. Patient assigned respiratory therapists surveyed patients/caregivers monthly for 1 year. Medical records were reviewed for respiratory hospitalizations. 225 patients were enrolled, aged 0 to 40 years (78%<18 yrs, 54.7%<10 yrs). 140 (62.2%)received mechanical ventilation, 85 (37.8%) received heat and humidity.
RESULTS: 287 episodes of TBS occurred in 225 patients; 4.1 episodes per 1000 trach days. 60% of patients had one or more episodes of TBS, 40% had no episodes. Underlying brain injury/CNS disease, primary lung disorder and congenital heart disease were diagnoses more often associated with TBS. TBS trended to occur with decreasing age and ventilator dependency. Presenting symptoms were increased need for suctioning (96.5%), discolored secretions (77.3%), decreased oxygen saturations (61.3%), increased cough (57%), tachycardia (57%) and fever (50.9%). Interventions included increased nebulizer treatments (74%), supplemental oxygen (52.3%), increased bronchodrainage (34.8%) and trach cultures (31.4%). 84% of patients had initial management by telephone and 37% had office or ER visits. Outpatient antibiotic management was limited to nebulized antibiotics or combination therapy in 23% and 60% respectively. Fluoroquinolones were the most frequently prescribed antibiotic. Median duration of treatment was 11 days. 39 patients accounted for 49 hospitalizations. Among hospitalized patients, pneumonia was diagnosed in 18 and documented viral infection in 9.
CONCLUSIONS: Tracheobronchitis episodes correlate with diagnosis, decreasing age and ventilator dependency. Most episodes are managed as outpatients. Pneumonia is infrequent.
CLINICAL IMPLICATIONS: Benchmark study on frequency and outcome of respiratory morbidities in a tracheostomised home care population.
DISCLOSURE: Roy Maynard: Employee: medical director for Pediatric Home Service, this is the company that collected the data for the presented abstract
The following authors have nothing to disclose: Josh Larson, Derek Hustvet, William Wheeler
No Product/Research Disclosure InformationChildren's Respiratory & Critical Care Specialists, P. A., Minneapolis, MN