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J Pediatr Intensive Care 2020; 09(01): 027-033
DOI: 10.1055/s-0039-1695733
Original Article
Georg Thieme Verlag KG Stuttgart · New York

High Rate of Medical Emergency Team Activation in Children with Tracheostomy

Brianna L. McKelvie
1   Division of Critical Care, Department of Pediatrics, Faculty of Medicine, Western University, Children's Hospital-London Health Sciences Centre, London, Ontario, Canada
,
Anna-Theresa Lobos
2   Division of Critical Care, Department of Pediatrics, Faculty of Medicine, University of Ottawa, Children's Hospital of Eastern Ontario, Ottawa, Ontario, Canada
,
Jason Chan
3   Children's Hospital of Eastern Ontario Research Institute, Ottawa, Ontario, Canada
,
Franco Momoli
3   Children's Hospital of Eastern Ontario Research Institute, Ottawa, Ontario, Canada
,
James Dayre McNally 
2   Division of Critical Care, Department of Pediatrics, Faculty of Medicine, University of Ottawa, Children's Hospital of Eastern Ontario, Ottawa, Ontario, Canada
3   Children's Hospital of Eastern Ontario Research Institute, Ottawa, Ontario, Canada
› Author Affiliations 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)

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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.

Keywords

tracheostomy - medical emergency team - rapid response system

Supplementary Material

 

  • 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
    CrossrefPubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 4 Funamura JL, Yuen S, Kawai K. , et al. Characterizing mortality in pediatric tracheostomy patients. Laryngoscope 2017; 127 (07) 1701-1706
    CrossrefPubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 6 Butnaru CS, Colreavy MP, Ayari S, Froehlich P. Tracheotomy in children: evolution in indications. Int J Pediatr Otorhinolaryngol 2006; 70 (01) 115-119
    CrossrefPubMedGoogle Scholar
  • 7 Carr MM, Poje CP, Kingston L, Kielma D, Heard C. Complications in pediatric tracheostomies. Laryngoscope 2001; 111 (11 Pt 1): 1925-1928
    CrossrefPubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 10 Buschbacher R. Outcomes and problems in pediatric pulmonary rehabilitation. Am J Phys Med Rehabil 1995; 74 (04) 287-293
    CrossrefPubMedGoogle Scholar
  • 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
    PubMedGoogle Scholar
  • 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
    PubMedGoogle Scholar
  • 13 Zhu H, Das P, Roberson DW. , et al. Hospitalizations in children with preexisting tracheostomy: a national perspective. Laryngoscope 2015; 125 (02) 462-468
    CrossrefPubMedGoogle Scholar
  • 14 Maharaj R, Raffaele I, Wendon J. Rapid response systems: a systematic review and meta-analysis. Crit Care 2015; 19 (01) 254
    CrossrefPubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 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
    PubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 27 Krmpotic K, Lobos AT. Clinical profile of children requiring early unplanned admission to the PICU. Hosp Pediatr 2013; 3 (03) 212-218
    PubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 31 Russell CJ, Simon TD. Care of children with medical complexity in the hospital setting. Pediatr Ann 2014; 43 (07) e157-e162
    CrossrefPubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 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
    PubMedGoogle Scholar
  • 36 Garrubba M, Turner T, Grieveson C. Multidisciplinary care for tracheostomy patients: a systematic review. Crit Care 2009; 13 (06) R177
    CrossrefPubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 40 Mitchell RB, Hussey HM, Setzen G. , et al. Clinical consensus statement: tracheostomy care. Otolaryngol Head Neck Surg 2013; 148 (01) 6-20
    CrossrefPubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 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
    PubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar