Incidence, Management and Outcome of
Tracheobronchitis 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
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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
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Methods
Prospective observational study conducted in a
predominantly pediatric population of tracheostomized
patients followed through a pediatric home care company
(Pediatric Home Service, Roseville, Minnesota).
Parents/patients gave informed consent to participate and
release hospital records.
Patient-assigned respiratory therapists surveyed
patients/caregivers monthly 10/1/2010 through 9/30/2011.
Hospital records reviewed on 44/48 (92%) of patients.
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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.
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Methods
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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.
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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
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Age Group by Sex
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Vent vs Humidity by Age Group
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Diagnostic Categories
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RESULTS
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Incidence of Tracheobronchitis
Symptoms
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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
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Management
• 89% of episodes initially managed by
telephone
• 52% only required phone management
• 43% ultimately had an office visit and/or
emergency room visit
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Management: Interventions
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Management: Antibiotic Treatment
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Management: Antibiotic Treatment
Antibiotic Prescriptions
Mean duration of antibiotic therapy was 18.8 days, median 10 days
35%
30%
25%
20%
15%
10%
5%
0%
fluoroquinilones cephalosporins penicillins macrolides
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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
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Length of Hospitalization
Total Days in Hospital
# of Total
Hospital Hospital
Stays Patients Days Min Max Mean Median Mode
All 38 366 2 41 9.63 5.0 4.0
1 30 181 2 35 6.03 4.0 3.0
2 6 113 4 40 18.83 16.5
3 2 72 31 41 36.00 36.0
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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)
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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 ≤ 0.05
Vent status was the only significant predictor of antibiotic episodes. Patients who do not have a vent are 0.411 times less
likely to have an antibiotic episode.
In the multivariate analysis only one variable, age, was found to be a significant predictor of hospitalizations. The results indicate
that older individuals are 0.26 times less likely to be hospitalized than younger patients.
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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
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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
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Incidence, Management and
Outcome of Tracheobronchitis in
a Tracheostomized Home Care
Population
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