39 / 232
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.
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.]
TABLE III.
Surveillance Direct Laryngoscopy and Bronchoscopy Operative
Interventions.
No. of Patients (%), n
5
817
Intervention
Debridement of suprastomal
granulation tissue
334/817 (41%)
Tracheostomy tube change
221/817 (27%)
Subglottic dilation
83/817 (10%)
Balloon dilation
42/83 (50%)
Microlaryngoscopy and CO
2
laser excision
19/83 (23%)
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%)
Laryngoscope 125: October 2015
Richter et al.: DLB in Children With Tracheostomies
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