ABSTRACT
INTRODUCTION: Children who use chronic home mechanical ventilation are at high risk for respiratory infections and mortality. They are also at increased risk for developing severe COVID-19 infection. The primary goal of this study was to evaluate the parental perception of the COVID-19 vaccine in pediatric patients with technology dependence. METHOD: We conducted a cross-sectional survey at a children's hospital between September 2021 and February 2022. A telephone or in-person interview was conducted to assesss parental attitudes toward the COVID-19 vaccine for their technology-dependent child. Technology-dependent groups included patients requiring (1) invasive mechanical ventilation via tracheostomy and (2) noninvasive mechanical ventilation via a facial interface. RESULTS: Fourteen of 44 participants (32%) of technology-dependent children were vaccinated for COVID-19 despite high parental vaccination and influenza vaccination rates. Twenty-eight patients (63% of total participants) were tracheostomy dependent. In the tracheostomy group, the COVID-19 vaccine rate was 28% versus 54% in the nontracheostomy group. Concern for vaccine side effects was the major reason for vaccine hesitancy (53%). More parents of vaccinated children than unvaccinated children were counseled by their primary care provider (85.7% vs. 46.7%; p = .02) or subspecialist (93% vs. 47%; p = .003). CONCLUSIONS: Our findings suggest counseling by primary care providers and subspecialists is important in overcoming COVID-19 vaccine hesitancy. Social media was identified as a major source of information, particularly among parents of unvaccinated patients.
ABSTRACT
Introduction: To evaluate pediatric tracheostomies performed at a tertiary care pediatric intensive care unit (PICU) before and after the Coronavirus disease-2019 (COVID-19) pandemic. Methods: A total of 57 pediatric tracheostomy patients performed at a tertiary care PICU were included. Prognostic scores including pediatric risk of mortality 2, pediatric index of mortality 2 and pediatric logistic organ dysfunction scores, the family education process and time to home discharge were evaluated according to time of tracheostomy (pre-pandemic vs. after pandemic) and responsible surgeon (pediatric surgeon vs. otolaryngologist). MedCalc® Statistical Software version 19.7.2 (MedCalc Software Ltd, Ostend, Belgium;https: //www.medcalc.org;2021) was used for statistical analysis. Results: A non-significant tendency for higher rate of pediatric surgery-based tracheostomies was noted after the pandemic (76.0 vs. 24.0%, p=0.134). No significant difference was noted between tracheostomies performed before vs. after the COVID-19 pandemic and those performed by otolaryngologists vs. pediatric surgeons in terms of prognostic scores and time to home discharge. Conclusion: Our findings emphasize the maintenance of high quality patient care for pediatric tracheostomy patients in accordance with standardized tracheostomy protocols and policies during the pandemic period with no significant difference between tracheostomies performed before and after the COVID-19 pandemic and those performed by pediatric surgeons vs. otolaryngologists in terms of prognostic scores and time to home discharge. © 2022, Galenos Publishing House. All rights reserved.
ABSTRACT
The COVID-19 pandemic is exacerbating longstanding challenges facing children with tracheostomies and their families. Myriad ethical concerns arising in the long-term care of children with tracheostomies during the COVID-19 pandemic revolve around inadequate access to care, healthcare resources, and rehabilitation services. Marginalized communities such as those from Black and Hispanic origins face disproportionate chronic illness because of racial and other underlying disparities. In this paper, we describe how these disparities also present challenges to children who are technology-dependent, such as those with tracheostomies and discuss the emerging ethical discourse regarding healthcare and resource access for this population during the pandemic.