2017 Sec 1 Green Book

Fig. 1. Surveillance direct laryngos- copy and bronchoscopy (DLB) results. The percent of DLB requir- ing intervention, those with preoper- ative symptoms (sx), and those with symptoms requiring intervention are presented in red. The percent of patients with preprocedure symp- toms are presented in blue. The operative interventions are pre- sented in green. All percentages are reported with the total number of patients (N 5 1,094) as the denomi- nator. [Color figure can be viewed in the online issue, which is available at www.laryngoscope.com.]

patients with chronic tracheostomies. However, this study is limited by its retrospective, single-institution design; further research may corroborate the ATS guidelines to establish a standardized clinical pathway for the care of pediatric tracheostomies. Further investigations are

needed for multi-institutional prospective studies to include randomization to time to surveillance DLB inter- val, risk stratification, and cost analysis.

CONCLUSION In pediatric tracheostomy patients undergoing sur- veillance DLB, most procedures (58%) required operative intervention for airway optimization. These data support our current practice of yearly surveillance DLB in asymptomatic pediatric tracheostomy patients and our aim to facilitate development of clinical practice guide- lines regarding chronic tracheostomy care in pediatric patients. Acknowledgments The authors acknowledge Dr. Wei Zhang and the Texas Children’s Hospital Outcomes and Impact Service for assistance with the statistical analysis. BIBLIOGRAPHY 1. Goldenberg D, Ari EG, Golz A, Danino J, Netzer A, Joachims HZ. Trache- otomy complications: a retrospective study of 1130 cases. Otolaryngol Head Neck Surg 2000;123:495–500. 2. Mahadevan M, Barber C, Salkeld L, Douglas G, Mills N. Pediatric trache- otomy: 17 year review. Int J Pediatr Otorhinolaryngol 2007;71: 1829–1835. 3. Tantinikorn W, Alper CM, Bluestone CD, Casselbrant ML. Outcomes in pediatric tracheotomy. Am J Otolaryngol 2003;24:131–137.

TABLE III. Surveillance Direct Laryngoscopy and Bronchoscopy Operative Interventions.

No. of Patients (%), n 5 817

Intervention Debridement of suprastomal granulation tissue Tracheostomy tube change

334/817 (41%)

221/817 (27%) 83/817 (10%)

Subglottic dilation Balloon dilation

42/83 (50%) 19/83 (23%)

Microlaryngoscopy and CO 2 laser excision

Serial dilation with rigid bronchoscopes

16/83 (20%)

Laser and dilation with balloon or rigid bronchoscope

6/83 (7%)

Tracheostomy stoma revision

50/817 (6%)

Decannulation

167/489 (34%)

Laryngotracheal reconstruction

43/489 (9%)

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