Clinical characteristics and gaps in palliative care among tracheostomized children: a retrospective observational study

TL;DR

This study examines the clinical features and palliative care gaps in children with tracheostomies in Brazil, showing a need for earlier palliative care involvement.

Contribution

The study identifies specific clinical and palliative care gaps in tracheostomized children and emphasizes the need for early multidisciplinary care.

Findings

Most tracheostomies were due to prolonged mechanical ventilation and airway obstruction.

Mortality was higher in infants, malnourished children, and those with multiple comorbidities.

Only 10.8% of children received palliative care consultations, mostly at end-of-life.

Abstract

To describe the clinical characteristics of tracheostomized children in Northeastern Brazil and to identify existing gaps in the indication and implementation of palliative care.

This retrospective descriptive study reviewed medical records of children under 15 years who underwent tracheostomy between 2008 and 2019 at a quaternary referral center.

Sixty-five tracheostomized patients with indications for palliative care were analyzed. The main reasons for palliative classification were acute life-threatening conditions (50.7 %) and chronic life-threatening conditions (20 %). The most frequent tracheostomy indications were prolonged invasive mechanical ventilation (46.1 %) and severe upper airway obstruction (23 %). The mortality rate was 30.7 %, higher among infants, severely malnourished children, those with Lansky scores below 40 % before tracheostomy, congenital heart disease, bronchopulmonary dysplasia, and multiple comorbidities. Only 10.8 % received palliative care consultations during hospitalization, all in the end-of-life care phase.

The results highlight a critical gap in the provision of palliative care to tracheostomized children. Early involvement of a multidisciplinary palliative care team is crucial to support clinical decision-making, family-centered care, and ensure quality of life. The proposed framework may facilitate timely referral and airway planning in the Intensive therapy, although further validation and qualitative research in various healthcare settings are needed.

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