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J Pediatr Intensive Care 2020; 09(01): 027-033
DOI: 10.1055/s-0039-1695733
DOI: 10.1055/s-0039-1695733
Original Article
High Rate of Medical Emergency Team Activation in Children with Tracheostomy
Funding There was no funding secured for this study.
Further Information
Publication History
07 May 2019
19 July 2019
Publication Date:
02 September 2019 (online)
Abstract
Pediatric in-patients with tracheostomy (PIT) are at high risk for clinical deterioration. Medical emergency teams (MET) have been developed to identify high-risk patients. This study compared MET activation rates between PITs and the general ward population. This was a retrospective cohort study conducted at a tertiary pediatric hospital. The primary outcome (MET activation) was obtained from a database. Between 2008 and 2014, the MET activation rate was significantly higher in the PIT group than the general ward population (14 vs. 2.9 per 100 admissions, p < 0.001). PITs are at significantly higher risk for MET activation. Strategies should be developed to reduce their risk on the wards.
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References
- 1 Watters K, O'Neill M, Zhu H, Graham RJ, Hall M, Berry J. Two-year mortality, complications, and healthcare use in children with medicaid following tracheostomy. Laryngoscope 2016; 126 (11) 2611-2617
- 2 Berry JG, Graham DA, Graham RJ. , et al. Predictors of clinical outcomes and hospital resource use of children after tracheotomy. Pediatrics 2009; 124 (02) 563-572
- 3 Lewis CW, Carron JD, Perkins JA, Sie KC, Feudtner C. Tracheotomy in pediatric patients: a national perspective. Arch Otolaryngol Head Neck Surg 2003; 129 (05) 523-529
- 4 Funamura JL, Yuen S, Kawai K. , et al. Characterizing mortality in pediatric tracheostomy patients. Laryngoscope 2017; 127 (07) 1701-1706
- 5 Zenk J, Fyrmpas G, Zimmermann T, Koch M, Constantinidis J, Iro H. Tracheostomy in young patients: indications and long-term outcome. Eur Arch Otorhinolaryngol 2009; 266 (05) 705-711
- 6 Butnaru CS, Colreavy MP, Ayari S, Froehlich P. Tracheotomy in children: evolution in indications. Int J Pediatr Otorhinolaryngol 2006; 70 (01) 115-119
- 7 Carr MM, Poje CP, Kingston L, Kielma D, Heard C. Complications in pediatric tracheostomies. Laryngoscope 2001; 111 (11 Pt 1): 1925-1928
- 8 Mahadevan M, Barber C, Salkeld L, Douglas G, Mills N. Pediatric tracheotomy: 17 year review. Int J Pediatr Otorhinolaryngol 2007; 71 (12) 1829-1835
- 9 Graf JM, Montagnino BA, Hueckel R, McPherson ML. Pediatric tracheostomies: a recent experience from one academic center. Pediatr Crit Care Med 2008; 9 (01) 96-100
- 10 Buschbacher R. Outcomes and problems in pediatric pulmonary rehabilitation. Am J Phys Med Rehabil 1995; 74 (04) 287-293
- 11 Caussade S, Paz F, Ramírez M. , et al. Clinical experience in home management of tracheotomized children [article in Spanish]. Rev Med Chil 2000; 128 (11) 1221-1226
- 12 Spentzas T, Auth M, Hess P, Minarik M, Storgion S, Stidham G. Natural course following pediatric tracheostomy. Int Pediatr 2008; 25 (01) 39-45
- 13 Zhu H, Das P, Roberson DW. , et al. Hospitalizations in children with preexisting tracheostomy: a national perspective. Laryngoscope 2015; 125 (02) 462-468
- 14 Maharaj R, Raffaele I, Wendon J. Rapid response systems: a systematic review and meta-analysis. Crit Care 2015; 19 (01) 254
- 15 McKelvie B, McNally JD, Chan J, Momoli F, Ramsay C, Lobos AT. Increased mortality and length of stay associated with medical emergency team review in hospitalized pediatric patients: a retrospective cohort study. Pediatr Crit Care Med 2017; 18 (06) 571-579
- 16 Stelfox HT, Bagshaw SM, Gao S. Characteristics and outcomes for hospitalized patients with recurrent clinical deterioration and repeat medical emergency team activation*. Crit Care Med 2014; 42 (07) 1601-1609
- 17 Calzavacca P, Licari E, Tee A. , et al. Features and outcome of patients receiving multiple Medical Emergency Team reviews. Resuscitation 2010; 81 (11) 1509-1515
- 18 Smith RJ, Santamaria JD, Faraone EE, Holmes JA, Reid DA, Tobin AE. The duration of hospitalization before review by the rapid response team: a retrospective cohort study. J Crit Care 2015; 30 (04) 692-697
- 19 Amin R, Sayal P, Syed F, Chaves A, Moraes TJ, MacLusky I. Pediatric long-term home mechanical ventilation: twenty years of follow-up from one Canadian center. Pediatr Pulmonol 2014; 49 (08) 816-824
- 20 Feudtner C, Christakis DA, Connell FA. Pediatric deaths attributable to complex chronic conditions: a population-based study of Washington State, 1980-1997. Pediatrics 2000; 106 (1 Pt 2): 205-209
- 21 Kotsakis A, Lobos AT, Parshuram C. , et al; Ontario Pediatric Critical Care Response Team Collaborative. Implementation of a multicenter rapid response system in pediatric academic hospitals is effective. Pediatrics 2011; 128 (01) 72-78
- 22 Tibballs J, Kinney S. Reduction of hospital mortality and of preventable cardiac arrest and death on introduction of a pediatric medical emergency team. Pediatr Crit Care Med 2009; 10 (03) 306-312
- 23 Valiani V, Gao S, Chen Z. , et al. In-hospital mobility variations across primary diagnoses among older adults. J Am Med Dir Assoc 2016; 17 (05) 465.e1-465.e8
- 24 Kuo SP, Bradley LA, Trussell LO. Heterogeneous kinetics and pharmacology of synaptic inhibition in the chick auditory brainstem. J Neurosci 2009; 29 (30) 9625-9634
- 25 Feudtner C, Feinstein JA, Zhong W, Hall M, Dai D. Pediatric complex chronic conditions classification system version 2: updated for ICD-10 and complex medical technology dependence and transplantation. BMC Pediatr 2014; 14 (01) 199
- 26 Cohen E, Berry JG, Camacho X, Anderson G, Wodchis W, Guttmann A. Patterns and costs of health care use of children with medical complexity. Pediatrics 2012; 130 (06) e1463-e1470
- 27 Krmpotic K, Lobos AT. Clinical profile of children requiring early unplanned admission to the PICU. Hosp Pediatr 2013; 3 (03) 212-218
- 28 Kinney S, Tibballs J, Johnston L, Duke T. Clinical profile of hospitalized children provided with urgent assistance from a medical emergency team. Pediatrics 2008; 121 (06) e1577-e1584
- 29 Bonafide CP, Roberts KE, Priestley MA. , et al. Development of a pragmatic measure for evaluating and optimizing rapid response systems. Pediatrics 2012; 129 (04) e874-e881
- 30 Edwards JD, Lucas AR, Stone PW, Boscardin WJ, Dudley RA. Frequency, risk factors, and outcomes of early unplanned readmissions to PICUs. Crit Care Med 2013; 41 (12) 2773-2783
- 31 Russell CJ, Simon TD. Care of children with medical complexity in the hospital setting. Pediatr Ann 2014; 43 (07) e157-e162
- 32 Wilkinson KA, Freeth H, Martin IC. Are we ‘on the right trach?’ The National Confidential Enquiry into Patient Outcome and Death examines tracheostomy care. J Laryngol Otol 2015; 129 (03) 212-216
- 33 Pritchett CV, Foster Rietz M, Ray A, Brenner MJ, Brown D. Inpatient nursing and parental comfort in managing pediatric tracheostomy care and emergencies. JAMA Otolaryngol Head Neck Surg 2016; 142 (02) 132-137
- 34 Clec'h C, Alberti C, Vincent F. , et al. Tracheostomy does not improve the outcome of patients requiring prolonged mechanical ventilation: a propensity analysis . Crit Care Med 2007; 35 (01) 132-138
- 35 Martinez GH, Fernandez R, Casado MS. , et al. Tracheostomy tube in place at intensive care unit discharge is associated with increased ward mortality. Respir Care 2009; 54 (12) 1644-1652
- 36 Garrubba M, Turner T, Grieveson C. Multidisciplinary care for tracheostomy patients: a systematic review. Crit Care 2009; 13 (06) R177
- 37 Cetto R, Arora A, Hettige R. , et al. Improving tracheostomy care: a prospective study of the multidisciplinary approach. Clin Otolaryngol 2011; 36 (05) 482-488
- 38 Hettige R, Arora A, Ifeacho S, Narula A. Improving tracheostomy management through design, implementation and prospective audit of a care bundle: how we do it. Clin Otolaryngol 2008; 33 (05) 488-491
- 39 Arora A, Hettige R, Ifeacho S, Narula A. Driving standards in tracheostomy care: a preliminary communication of the St Mary's ENT-led multi disciplinary team approach. Clin Otolaryngol 2008; 33 (06) 596-599
- 40 Mitchell RB, Hussey HM, Setzen G. , et al. Clinical consensus statement: tracheostomy care. Otolaryngol Head Neck Surg 2013; 148 (01) 6-20
- 41 Bedwell JR, Pandian V, Roberson DW, McGrath BA, Cameron TSBM, Brenner MJ. Multidisciplinary tracheostomy care: how collaboratives drive quality improvement. Otolaryngol Clin North Am 2019; 52 (01) 135-147
- 42 Lobos A-T, Fernandes R, Willams K, Ramsay C, McNally JD. Routine medical emergency team assessments of patients discharged from the PICU: description of a medical emergency team follow-up program. Pediatr Crit Care Med 2015; 16 (04) 359-365
- 43 Nguyen LHP, Bank I, Fisher R, Mascarella M, Young M. Managing the airway catastrophe: longitudinal simulation-based curriculum to teach airway management. J Otolaryngol Head Neck Surg 2019; 48 (01) 10
- 44 Ambardekar AP, Black S, Singh D. , et al. The impact of simulation‐based medical education on resident management of emergencies in pediatric anesthesiology. Pediatr Anesth 2019; 27 (07) 753-759
- 45 Pelaes de Carvalho T, Spitaletti Araujo NS, Curcio D, Rebelo Gonçalves MI. Tracheostomized patients care: efficacy of a brief theoretical education program for nursing personnel . Support Care Cancer 2009; 17 (06) 749-751
- 46 Agarwal A, Marks N, Wessel V. , et al. Improving knowledge, technical skills, and confidence among pediatric health care providers in the management of chronic tracheostomy using a simulation model. Pediatr Pulmonol 2016; 51 (07) 696-704
- 47 Dorton LH, Lintzenich CR, Evans AK. Simulation model for tracheotomy education for primary health-care providers. Ann Otol Rhinol Laryngol 2014; 123 (01) 11-18
- 48 Khademi A, Cuccurullo SJ, Cerillo LM. , et al. Tracheostomy management skills competency in physical medicine and rehabilitation residents: a method for development and assessment. Am J Phys Med Rehabil 2012; 91 (01) 65-74