0
Incidence, Management and Outcome ofTracheobronchitis in a Tracheostomized        Home Care Population                    ...
Purpose• A paucity of information exists on the  actual incidence, management and  outcome of tracheobronchitis in  trache...
MethodsProspective observational study conducted in apredominantly pediatric population of tracheostomizedpatients followe...
Methods• Tracheobronchitis was defined as a new or  altered chronic antibiotic prescription to  treat acute respiratory sy...
Methods  5 of 24
Methods• Statistics: A study specific data reporting tool was  developed to facilitate data collection from a patient  reg...
Methods• Demographics  – 225 patients enrolled (initially 238, 13 excluded    due to inability to obtain reliable informat...
Age Group by Sex      8 of 24
Vent vs Humidity by Age Group             9 of 24
Diagnostic Categories        10 of 24
RESULTS  11 of 24
Incidence of Tracheobronchitis          Symptoms             12 of 24
Incidence of Tracheobronchitis• 69,515 tracheostomy days/225 patients• 287 tracheobronchitis episodes/225 patients• 1.28 t...
Management• 89% of episodes initially managed by  telephone• 52% only required phone management• 43% ultimately had an off...
Management: Interventions          15 of 24
Management: Antibiotic Treatment              16 of 24
Management: Antibiotic Treatment                              Antibiotic Prescriptions              Mean duration of antib...
Outcomes• Hospitalizations  – 48 respiratory hospitalizations among 38 patients  – Hospital records reviewed on 44 out of ...
Length of Hospitalization                                        Total Days in Hospital# of                   TotalHospita...
Outcomes• 37.5% (18/48) of hospitalizations had been treated with  antibiotics prior to admission• 44% (21/48) of hospital...
Risk Factors for Tracheobronchitis                and Hospitalization   Factor                                      Odds R...
Conclusions• Incidence of Tracheobronchitis   – 4.1 episodes per 1000/trach days   – 60% of patients had one or more episo...
Acknowledgements• Clinical Staff at Pediatric Home Service• Families and patients that agreed to  participate in the study...
Incidence, Management andOutcome of Tracheobronchitis in a Tracheostomized Home Care          Population             24 of...
Upcoming SlideShare
Loading in...5
×

Incidence, Management and Outcome of Tracheobronchitis in a Tracheostomized Home Care Population

804

Published on

0 Comments
0 Likes
Statistics
Notes
  • Be the first to comment

  • Be the first to like this

No Downloads
Views
Total Views
804
On Slideshare
0
From Embeds
0
Number of Embeds
2
Actions
Shares
0
Downloads
3
Comments
0
Likes
0
Embeds 0
No embeds

No notes for slide

Transcript of "Incidence, Management and Outcome of Tracheobronchitis in a Tracheostomized Home Care Population"

  1. 1. Incidence, Management and Outcome ofTracheobronchitis in a Tracheostomized Home Care Population Roy Maynard1,2, M.D., Josh Larson1, MS, RHIA, RRT-NPS, Derek Hustvet1, BS, RRT-NPS William Wheeler2, M.D. 1. Pediatric Home Service, Roseville, MN 2. Children’s Respiratory & Critical Care Specialists, P.A., Minneapolis, MN 1 of 24
  2. 2. Purpose• A paucity of information exists on the actual incidence, management and outcome of tracheobronchitis in tracheostomized patients in home care. – Standard of care in our community – Symptoms and interventions – Episodes of tracheobronchitis and pneumonia – Frequency of respiratory hospitalization – Identify risk factors 2 of 24
  3. 3. MethodsProspective observational study conducted in apredominantly pediatric population of tracheostomizedpatients followed through a pediatric home care company(Pediatric Home Service, Roseville, Minnesota).Parents/patients gave informed consent to participate andrelease hospital records.Patient-assigned respiratory therapists surveyedpatients/caregivers monthly 10/1/2010 through 9/30/2011.Hospital records reviewed on 44/48 (92%) of patients. 3 of 24
  4. 4. Methods• Tracheobronchitis was defined as a new or altered chronic antibiotic prescription to treat acute respiratory symptoms.• Pneumonia diagnosed by review of hospital admission records documenting new infiltrates on CXR. 4 of 24
  5. 5. Methods 5 of 24
  6. 6. Methods• Statistics: A study specific data reporting tool was developed to facilitate data collection from a patient registry and patient chart abstraction. A HIPAA compliant dataset was created for analysis. Categorical variables (e.g. age group, route of antibiotic administration, diagnosis group) were reported as proportion of patients and patient visits; continuous variables (e.g. patient age, number of days in hospital; number of antibiotic episodes, number of trach days) were reported as means and standard deviations. Bivariate associations were tested with chi-square (e.g. diagnosis group and tracheobronchitis episode; a p- value ≤ 0.05, two-tailed was used to determine statistical significance. SAS v9.3 (SAS Institute, Cary, NC, USA) was used for all data management and analysis. 6 of 24
  7. 7. Methods• Demographics – 225 patients enrolled (initially 238, 13 excluded due to inability to obtain reliable information), 7 patients expired during the study – Cumulative tracheostomy days counted – 175 patients <18 years of age – 50 patients >18 years of age – 95 females/130 males – Vent=140 patients, H&H=85 patients 7 of 24
  8. 8. Age Group by Sex 8 of 24
  9. 9. Vent vs Humidity by Age Group 9 of 24
  10. 10. Diagnostic Categories 10 of 24
  11. 11. RESULTS 11 of 24
  12. 12. Incidence of Tracheobronchitis Symptoms 12 of 24
  13. 13. Incidence of Tracheobronchitis• 69,515 tracheostomy days/225 patients• 287 tracheobronchitis episodes/225 patients• 1.28 tracheobronchitis episodes/patient/year• 4.1 tracheobronchitis episodes/1,000 trach days• 60% of patients had one or more episodes of tracheobronchitis• 40% of patients had no episodes of tracheobronchitis 13 of 24
  14. 14. Management• 89% of episodes initially managed by telephone• 52% only required phone management• 43% ultimately had an office visit and/or emergency room visit 14 of 24
  15. 15. Management: Interventions 15 of 24
  16. 16. Management: Antibiotic Treatment 16 of 24
  17. 17. Management: Antibiotic Treatment Antibiotic Prescriptions Mean duration of antibiotic therapy was 18.8 days, median 10 days35%30%25%20%15%10%5%0% fluoroquinilones cephalosporins penicillins macrolides 17 of 24
  18. 18. Outcomes• Hospitalizations – 48 respiratory hospitalizations among 38 patients – Hospital records reviewed on 44 out of 48 respiratory hospitalizations (92%) – 17% of patients had at least one hospitalization – 83% of patients had no respiratory hospitalizations 18 of 24
  19. 19. Length of Hospitalization Total Days in Hospital# of TotalHospital HospitalStays Patients Days Min Max Mean Median ModeAll 38 366 2 41 9.63 5.0 4.01 30 181 2 35 6.03 4.0 3.02 6 113 4 40 18.83 16.53 2 72 31 41 36.00 36.0 19 of 24
  20. 20. Outcomes• 37.5% (18/48) of hospitalizations had been treated with antibiotics prior to admission• 44% (21/48) of hospitalizations had a diagnosis of pneumonia• 19% (9/48) of hospitalized patients had documented respiratory viral infection (5 RSV, 2 influenza A, 1 adenovirus, 1 humanmetapneumovirus)• 8/287 (2.8%) of tracheobronchitis episodes treated with antibiotics as outpatients diagnosed in hospital with non-viral pneumonia (progression of tracheobronchitis to pneumonia) 20 of 24
  21. 21. Risk Factors for Tracheobronchitis and Hospitalization Factor Odds Ratio Odds Ratio Hospitalization Tracheobronchitis Sex: Female 1.43 (0.810; 2.540) 1.29 (0.20 2.201) p-value=0.2163 p-value = 0.4924 HV: Vent 0.411 (0.227; 0.744) 0.51 (0.232; 1.140) p-value = 0.0033* p-value = 0.1017 Dx: CNS 2.09 (1.092; 3.999) 2.45 (0.957; 6.266) p-value = 0.1548 p-value = 0.2993 Dx: Lung 1.81 (0.818; 4.016) 2.65 (0.950; 7.414) p-value = 0.5418 p-value = 0.2227 Age: <12 0.56 (0.299; 1.028) 0.26 (0.103; 0.667) p-value = 0.0613 p-value = 0.0056**statistically significant p-value ≤ 0.05Vent status was the only significant predictor of antibiotic episodes. Patients who do not have a vent are 0.411 times lesslikely to have an antibiotic episode.In the multivariate analysis only one variable, age, was found to be a significant predictor of hospitalizations. The results indicatethat older individuals are 0.26 times less likely to be hospitalized than younger patients. 21 of 24
  22. 22. Conclusions• Incidence of Tracheobronchitis – 4.1 episodes per 1000/trach days – 60% of patients had one or more episodes• Incidence of Respiratory Hospitalization – 17% of patients had at least one respiratory hospitalization – 20% of inpatients had documented viral infections – Nearly half of hospitalized patients diagnosed with pneumonia – Most hospitalizations are brief (mode 3 days)• Risk Factors for tracheobronchitis and/or respiratory hospitalization include age and ventilator dependency 22 of 24
  23. 23. Acknowledgements• Clinical Staff at Pediatric Home Service• Families and patients that agreed to participate in the study• Administrative assistant Marlene Brekke• DataIQ for statistical support 23 of 24
  24. 24. Incidence, Management andOutcome of Tracheobronchitis in a Tracheostomized Home Care Population 24 of 24
  1. A particular slide catching your eye?

    Clipping is a handy way to collect important slides you want to go back to later.

×