Surveillance direct laryngoscopy and bronchoscopy in children with tracheostomies

Objectives/hypothesis: To determine utility of surveillance direct laryngoscopy and bronchoscopy (DLB) in children with chronic tracheostomies by examining the frequency of operative intervention in children undergoing an annual DLB.

Study design: Retrospective medical record review and analysis of operative findings and interventions.

Methods: A retrospective chart review was conducted of all children with tracheostomies who underwent surveillance DLB between 2003 and 2012 at a tertiary children's hospital. Charts were reviewed for demographics, indication for tracheotomy, symptoms prior to DLB, dates of DLB, and operative findings and interventions.

Results: A total of 489 patients underwent 1,094 DLBs. Two hundred fifty-three DLBs (23%) were accompanied by preprocedural symptoms including bleeding; increased secretions; infection; and changes in ventilation requirement, swallow, or voice. Six hundred nineteen procedures (58%) required 817 interventions. Common interventions performed included debridement of granulation tissue (41%), tracheostomy tube exchange (27%), and subglottic dilation (10%). The presence of preprocedural symptoms and indication for tracheostomy did not predict need for intervention during DLB (P > .05).

Conclusions: In pediatric tracheostomy patients undergoing surveillance 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 aim to facilitate the development of clinical practice guidelines regarding chronic tracheostomy care in pediatric patients.

Level of evidence: 4