The Trach Safe Initiative: A Quality Improvement Initiative to Reduce Mortality among Pediatric Tracheostomy Patients.

Objective: To describe the Trach Safe Initiative and assess its impact on unanticipated tracheostomy-related mortality in outpatient tracheostomy-dependent children (TDC).

Methods: An interdisciplinary team including parents and providers designed the initiative with quality improvement methods. Three practice changes were prioritized: (1) surveillance airway endoscopy prior to hospital discharge from tracheostomy placement, (2) education for community-based nurses on TDC-focused emergency airway management, and (3) routine assessment of airway events for TDC in clinic.

Surveillance endoscopy after tracheostomy placement in children: Findings and interventions.

Objectives/hypothesis: The Seattle Children's Hospital implemented the Trach Safe Initiative to improve airway safety in tracheostomy-dependent children (TDC). A key tenet of this initiative is surveillance endoscopy. The objectives of this study were to describe the prevalence of abnormal airway changes in TDC, identify risk factors for these changes, and describe the frequency of airway interventions.

Use of a lung model to assess mechanical in-exsufflator therapy in infants with tracheostomy.

Background: The mechanical in-exsufflator (MIE) is commonly used to augment cough in patients with neuromuscular disease from infancy to adulthood. Little is known about the alveolar pressures, lung volumes, and expiratory flow rates generated by the MIE when used via tracheostomy tube in infants and children.

Methods: A high-fidelity mechanical lung model was programmed to simulate infants with tracheostomy tubes.

Prenatal bilateral extravaginal testicular torsion--a case presentation.

A newborn male presented at birth with findings consistent with bilateral testicular torsion. Preoperative ultrasound demonstrated no flow to either testicle, and he underwent surgery, during which bilateral extravaginal testicular torsion was confirmed. The right testicle was grossly necrotic and orchidectomy was performed, whereas the left testicle was indeterminate and underwent detorsion and orchidopexy.

Perinatal extravaginal torsion of the testis in the first month of life is a salvageable event.

Objectives: To determine the effectiveness of immediate surgical exploration in salvaging perinatal testicular torsion.

Methods: A retrospective analysis from 1995 to 2000 of boys younger than 30 days of age with surgically documented extravaginal testicular torsion was conducted. All cases were diagnosed after a normal testicular examination by a neonatologist, and all patients underwent urgent exploration to confirm the exact diagnosis and attempt testicular salvage by detorsion with bilateral orchiopexy.