Assistant Professor University of Texas Southwestern Medical Center Dallas, Texas
Objective: To characterize the cause of death among children with a tracheostomy.
Method: Prospective cohort series of all pediatric patients ( <18 years) that had a tracheostomy placed at a tertiary care institution between 2015 and 2020. The location and cause of death were recorded along with patient demographics and age.
Results: A total 273 tracheostomies were placed with 46 mortalities reviewed for a mortality rate of 17% or 168 deaths per 1000 tracheostomies. Mean age at placement was 1.7 years (SD: 3.4) and mean age at death was 2.9 years (SD: 3.5). Most tracheostomies were placed for respiratory failure (N=33, 72%). The mean time to death after tracheostomy was 1.2 years (SD: 1.2) and 28% (N=13) occurred during the same admission as placement. Median time to death after hospital discharge was 1.1 y (IQR: 0.3-1.7). Etiology of death was respiratory failure (30%, N=14), cardiopulmonary arrest (17%, N=8), unknown (43%, N=20), or secondary to a tracheostomy-related complication for 9% (N=4). Children that died of tracheostomy-related events were a mean age of 2.1 years (SD: 1.5), half were male and all had an indication of respiratory failure. Location of death was in intensive care units for 43% (N=20) and 32% died at home (N=15). Comfort care measures were taken for 37% (N=17).
Conclusion: Nearly one-third of children with a tracheostomy who expire will do so during the same admission as tracheostomy placement. While progression of underlying disease will lead to most deaths, 9% will be a result of a tracheostomy-related complication which represents a meaningful target for improved caregiver education and safety training programs.