Foam Versus Silver-Impregnated Foam Dressings for Pediatric Tracheostomy: A Randomized Trial.

OBJECTIVES

Peristomal skin complications occur in up to 29% of pediatric tracheostomy patients. While foam dressings have demonstrated superiority over traditional gauze, comparative evidence regarding silver-impregnated versus standard foam dressings remains limited. This study aimed to compare the effectiveness of standard foam versus silver-impregnated foam dressing in preventing peristomal complications following pediatric tracheostomy.

METHODS

This prospective randomized controlled trial enrolled 50 pediatric patients (aged 0-18 years) undergoing elective tracheostomy between March 2022 and July 2024. Patients were randomly assigned to receive either standard foam dressing (Group A, n = 25) or silver-impregnated foam dressing (Group B, n = 25). All patients followed a standardized postoperative care protocol. The primary outcome was incidence of peristomal complications during the first postoperative month. Secondary outcomes included pressure ulcer risk assessment using the Braden Q Scale and wound staging according to the National Pressure Injury Advisory Panel (NPIAP) classification.

RESULTS

The complication rate was 12% (n = 3) in the foam dressing group and 8% (n = 2) in the silver-impregnated foam dressing group, and no statistically significant difference was detected (risk difference: 4%, 95% CI: -0.114 to 0.194, p = 1.000). No significant differences were observed in Braden Q scores on postoperative days 1, 7, 14, and 21 (p > 0.05). NPIAP staging revealed comparable pressure ulcer severity between groups (p = 1.000).

CONCLUSION

No statistically significant difference was detected between standard foam and silver-impregnated foam dressing when combined with standardized care protocols. However, the small sample size limits statistical power to detect clinically meaningful differences, and as this study was not designed as a non-inferiority trial, equivalence cannot be concluded. Larger trials are needed to confirm these findings. Standard foam dressing may be a lower-cost option for routine postoperative wound management in pediatric tracheostomy patients.

LEVEL OF EVIDENCE: 2. Trial Registration: NCT07392294.