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de Miranda LDG, Borges LAA, Zavaglia LC, Mesquita TCL, Leite LR, Aguiar LT, de Mendonça Picinin IF. Decannulation protocol in pediatric patients: case series study. REVISTA PAULISTA DE PEDIATRIA : ORGAO OFICIAL DA SOCIEDADE DE PEDIATRIA DE SAO PAULO 2024; 43:e2023187. [PMID: 39319994 PMCID: PMC11421412 DOI: 10.1590/1984-0462/2025/43/2023187] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/23/2023] [Accepted: 05/17/2024] [Indexed: 09/26/2024]
Abstract
OBJECTIVE The aim of this study was to describe the phases of a decannulation protocol and the results from its application in hospitalized children. METHODS This is a retrospective, observational study. Data were collected from medical records of decannulated patients followed up in a pediatric hospital in Belo Horizonte, Minas Gerais between 2011 and 2021. RESULTS Among the children followed up in the service (n=526), 23% (n=120) were successfully decannulated. Children aged between 2 months and 16 years, with a mean age of 4 years, 69% of whom were male, were evaluated. About 75% of the patients have tracheostomy due to upper airway obstruction and 60% of these due to acquired subglottic stenosis. At the beginning of the decannulation protocol, 5.5% of the patients had moderate oropharyngeal dysphagia, while 80.4% had normal swallowing. Correction in the upper airway pre-decannulation was performed in 39.5% of the patients, dilation in 63.8%, and endoscopic correction was performed in 55.3%. After performing the decannulation, none of the patients had complications. CONCLUSIONS The described decannulation protocol is safe, since no complications such as death and need for recannulation happened.
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Affiliation(s)
- Luciana Diniz Gomide de Miranda
- Fundação Hospitalar do Estado de Minas Gerais, Hospital Infantil João Paulo II, Serviço de Assistência Integral à Criança Traqueostomizada, Belo Horizonte, MG, Brazil
| | | | | | - Tereza Cristina Lara Mesquita
- Fundação Hospitalar do Estado de Minas Gerais, Hospital Infantil João Paulo II, Serviço de Assistência Integral à Criança Traqueostomizada, Belo Horizonte, MG, Brazil
| | - Luanna Rodrigues Leite
- Fundação Hospitalar do Estado de Minas Gerais, Hospital Infantil João Paulo II, Serviço de Assistência Integral à Criança Traqueostomizada, Belo Horizonte, MG, Brazil
| | | | - Isabela Furtado de Mendonça Picinin
- Fundação Hospitalar do Estado de Minas Gerais, Hospital Infantil João Paulo II, Serviço de Assistência Integral à Criança Traqueostomizada, Belo Horizonte, MG, Brazil
- Faculdade de Ciências Médicas de Minas Gerais, Belo Horizonte, MG, Brazil
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Lloyd AM, Behzadpour HK, Rana MS, Espinel AG. Time considerations and outcomes in pediatric tracheostomy decannulation. Int J Pediatr Otorhinolaryngol 2024; 179:111934. [PMID: 38537449 DOI: 10.1016/j.ijporl.2024.111934] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2024] [Revised: 03/06/2024] [Accepted: 03/24/2024] [Indexed: 04/14/2024]
Abstract
OBJECTIVE The study objective is to identify factors that impact the time to decannulation in pediatric patients ages 0 through 18 years who are tracheostomy-dependent. METHODS This retrospective chart review from January 1, 2005 through December 31, 2020 identified pediatric tracheostomy patients at a single pediatric institution. Data extracted included demographic, socioeconomic factors, and clinical characteristics. Multivariate regression and survival analysis were used to identify factors associated with successful decannulation and decreased time with tracheostomy. RESULTS Of the 479 tracheostomy-dependent patients identified, 162 (33.8%) were decannulated. Time to decannulation ranged from 0.5 months to 189.2 months with median of 24 months (IQR 12.91-45.71). In the multivariate analysis, patients with bronchopulmonary dysplasia (p = 0.021) and those with Passy-Muir® Valve at discharge (p = 0.015) were significantly associated with decannulation. In contrast, neurologic comorbidities (p = 0.06), presence of gastrostomy tube (p < 0.001), or discharged on a home ventilator (p < 0.001) were associated with indefinite tracheostomy. When adjusting for age, sex, race, ethnicity, and insurance status, for every one month delay in establishment of outpatient otolaryngology care, time to decannulation was delayed by 0.5 months (p = 0.010). For each additional outpatient otolaryngology follow-up visit, time to decannulation increased by 3.36 months (p < 0.001). CONCLUSIONS Decannulation in pediatric tracheostomy patients is multifactorial. While timely establishment of outpatient care did correlate with quicker decannulation, factors related to medical complexity may have a greater impact on time to decannulation. Our results can help guide institutional decannulation protocols, as well as provide guidance when counseling families regarding tracheostomy expectations.
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Affiliation(s)
- Ashley M Lloyd
- Division of Otolaryngology, George Washington University Hospital, Washington, DC, USA.
| | - Hengameh K Behzadpour
- Division of Pediatric Otolaryngology, Children's National Hospital, Washington, DC, USA
| | - Md Sohel Rana
- Department of Surgery, Children's National Hospital, Washington DC, USA
| | - Alexandra G Espinel
- Division of Pediatric Otolaryngology, Children's National Hospital, Washington, DC, USA
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Kawar L, Clark E, Kubba H. External peri-stomal skin granulations in paediatric tracheostomy: Incidence, outcomes and a proposed treatment algorithm. Int J Pediatr Otorhinolaryngol 2024; 176:111821. [PMID: 38147731 DOI: 10.1016/j.ijporl.2023.111821] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/30/2023] [Revised: 11/15/2023] [Accepted: 12/04/2023] [Indexed: 12/28/2023]
Abstract
BACKGROUND External peri-stomal skin granulations after tracheostomy in children are common and may interfere with routine tube changes. This study is the first attempt to describe the incidence and outcomes, along with a proposed treatment algorithm. METHODS A retrospective review of all inpatient children with a tracheostomy between January 2020 and May 2022 at the Royal Hospital for Children (RHC) in Glasgow. The presence of external peri-stomal granulation, date of onset and resolution, recurrence and treatment modalities were noted. All tracheostomy tubes used during the study period were made of silicone. RESULTS A total of 50 episodes of peri-stomal granulation were identified in 27 children (52 %). Median age at the end of the study period was 4.3 years, with younger children experiencing more frequent granulation. 3 episodes interfered with tracheostomy tube changes. Time to resolution of the granulation was significantly longer with topical steroid/antimicrobial ointment monotherapy, but recurrence was less common when this was used a first treatment modality. CONCLUSION Non-invasive measures such as topical anti-microbials should be used in the first instance when managing external stoma-site granulations. More invasive measures, such as silver nitrate cautery and surgical excision, should be considered if the granulation tissue is not improving or when it poses a risk to safe tube changes.
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Affiliation(s)
- Luai Kawar
- University College Hospital, 235 Euston Road, London NW1 2BU, England, UK.
| | - Emma Clark
- Department of Paediatric Otolaryngology, Royal Hospital for Children, 1345 Govan Road, Glasgow, G51 4TF, Scotland, UK.
| | - Haytham Kubba
- Department of Paediatric Otolaryngology, Royal Hospital for Children, 1345 Govan Road, Glasgow, G51 4TF, Scotland, UK.
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Ullman A, Hyun A, Gibson V, Newall F, Takashima M. Device Related Thrombosis and Bleeding in Pediatric Health Care: A Meta-analysis. Hosp Pediatr 2024; 14:e25-e41. [PMID: 38161187 DOI: 10.1542/hpeds.2023-007345] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2024]
Abstract
CONTEXT The risk of invasive device-related thrombosis and bleeding contributes to morbidity and mortality, yet their prevalence by device-types is poorly understood. OBJECTIVES This study aimed to estimate pooled proportions and rates of thrombotic and bleeding complications associated with invasive devices in pediatric health care. DATA SOURCES Medline, CINAHL, Embase, Web of Science, Scopus, Cochrane CENTRAL, clinical trial registries, and unpublished study databases were searched. STUDY SELECTION Cohort studies and trials published from January 2011 to June 2022, including (1) indwelling invasive devices, (2) pediatric participants admitted to a hospital, (3) reporting thrombotic and bleeding complications, and (4) published in English, were included. DATA EXTRACTION Meta-analysis of observational studies in epidemiology guidelines for abstracting and assessing data quality and validity were used. MAIN OUTCOMES AND MEASURES Device-specific pooled thromboses (symptomatic, asymptomatic, unspecified) and bleeding (major, minor). RESULTS Of the 107 studies, 71 (66%) focused on central venous access devices. Symptomatic venous thromboembolism in central venous access devices was 4% (95% confidence interval [CI], 3-5; incidence rate 0.03 per 1000 device-days, 95% CI, 0.00-0.07), whereas asymptomatic was 10% (95% CI, 7-13; incidence rate 0.25 per 1000 device-days, 95% CI, 0.14-0.36). Both ventricular assist devices (28%; 95% CI, 19-39) and extracorporeal membrane oxygenation (67%; 95% CI, 52-81) were often associated with major bleeding complications. CONCLUSIONS This comprehensive estimate of the incidence and prevalence of device-related thrombosis and bleeding complications in children can inform clinical decision-making, guide risk assessment, and surveillance.
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Affiliation(s)
- Amanda Ullman
- School of Nursing, Midwifery and Social Work, The University of Queensland, Queensland, Australia
- Centre for Children's Health Research, Children's Health Queensland Hospital and Health Service, Queensland, Australia
- NHMRC Centre for Research Excellence in Wiser Wound Care, Griffith University, Queensland, Australia
| | - Areum Hyun
- School of Nursing, Midwifery and Social Work, The University of Queensland, Queensland, Australia
| | - Victoria Gibson
- School of Nursing, Midwifery and Social Work, The University of Queensland, Queensland, Australia
- Centre for Children's Health Research, Children's Health Queensland Hospital and Health Service, Queensland, Australia
| | - Fiona Newall
- Royal Children's Hospital Melbourne, Victoria, Australia
- The University of Melbourne, Victoria, Australia
| | - Mari Takashima
- School of Nursing, Midwifery and Social Work, The University of Queensland, Queensland, Australia
- Centre for Children's Health Research, Children's Health Queensland Hospital and Health Service, Queensland, Australia
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Vasconcellos Severo G, Schweiger C, Manica D, Marostica PJC. Tracheostomized children tracheal colonization and antibiotic resistance profile - A STROBE analysis. Eur Ann Otorhinolaryngol Head Neck Dis 2023; 140:71-76. [PMID: 35915024 DOI: 10.1016/j.anorl.2022.07.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2022] [Revised: 06/14/2022] [Accepted: 07/04/2022] [Indexed: 11/03/2022]
Abstract
AIMS To verify the prevalence of Potentially pathogenic bacteria (PPB) and their antimicrobial resistance profile in tracheal aspirates of children with tracheostomy and compare it to clinical data. METHODS A cross-sectional study was conducted in patients aged 0-18 years who all underwent tracheostomy cannula change (TCC) performed by the Otolaryngology Unit at Hospital de Clínicas de Porto Alegre, Brazil, between October, 2017 and December, 2018. Patients were submitted, at the time of TCC, to a tracheal aspirate through the tracheostomy and secretion was sent to microbiological analysis and antimicrobial susceptibility testing. Clinical data were evaluated through available patients' electronic medical records. RESULTS Forty-four patients had their tracheostomy aspirate cultured and all but one presented PPB growth (97.7%). Median age was 3 years-old. Pseudomonas aeruginosa was the most prevalent bacteria (56.9%) and it was resistant to gentamycin, amikacin and cefepime in 36%, 28% and 12% of the culture tests, respectively. P. aeruginosa resistance to gentamycin and to cefepime suggested an association with the number of antibiotic classes used in the 12 months before enrollment (both p=0.04) and with 2 or more hospital admissions in the same period (p=0.03 and p=0.02, respectively). Staphylococcus aureus was isolated in 9.1% and there was no MRSA. CONCLUSION It was found a 97.7% prevalence of PPB in the cultured aspirates; the most prevalent bacterium was P. aeruginosa and there was no MRSA identification. Data suggest an association between P. aeruginosa antimicrobial resistance with previous use of antibiotic therapy.
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Affiliation(s)
- G Vasconcellos Severo
- Serviço de Otorrinolaringologia e Cirurgia de Cabeça e Pescoço, Hospital de Clínicas de Porto Alegre (HCPA), Rua Ramiro Barcelos, 2350 - Santa Cecilia, 90035-007 Porto Alegre, Rio Grande do Sul, Brazil; Programa de Pós-Graduação em Saúde da Criança e do Adolescente, Universidade Federal do Rio Grande do Sul (UFRGS), rua Ramiro Barcelos, 2400 sala 220, 90035-003 Porto Alegre, Rio Grande do Sul, Brazil.
| | - C Schweiger
- Serviço de Otorrinolaringologia e Cirurgia de Cabeça e Pescoço, Hospital de Clínicas de Porto Alegre (HCPA), Rua Ramiro Barcelos, 2350 - Santa Cecilia, 90035-007 Porto Alegre, Rio Grande do Sul, Brazil; Programa de Pós-Graduação em Saúde da Criança e do Adolescente, Universidade Federal do Rio Grande do Sul (UFRGS), rua Ramiro Barcelos, 2400 sala 220, 90035-003 Porto Alegre, Rio Grande do Sul, Brazil
| | - D Manica
- Serviço de Otorrinolaringologia e Cirurgia de Cabeça e Pescoço, Hospital de Clínicas de Porto Alegre (HCPA), Rua Ramiro Barcelos, 2350 - Santa Cecilia, 90035-007 Porto Alegre, Rio Grande do Sul, Brazil
| | - P J C Marostica
- Programa de Pós-Graduação em Saúde da Criança e do Adolescente, Universidade Federal do Rio Grande do Sul (UFRGS), rua Ramiro Barcelos, 2400 sala 220, 90035-003 Porto Alegre, Rio Grande do Sul, Brazil; Unidade de Pneumologia Pediátrica, HCPA, Rua Ramiro Barcelos, 2350 - Santa Cecilia, 90035-007, Porto Alegre, Rio Grande do Sul, Brazil
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Yukkaldıran A, Doblan A. Pediatric Tracheostomy at a Tertiary Healthcare Institution: A Retrospective Study Focused on Outcomes. Indian J Otolaryngol Head Neck Surg 2022; 74:6438-6443. [PMID: 32904612 PMCID: PMC7457211 DOI: 10.1007/s12070-020-02093-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2020] [Accepted: 08/24/2020] [Indexed: 02/07/2023] Open
Abstract
The aim of this study was to retrospectively evaluate all pediatric tracheotomies that had been performed at Sanliurfa Training and Research Hospital From September 2016 to July 2019. A retrospective study was performed on pediatric patients who had undergone tracheostomy during the three-year study period. Patient data were reviewed for the following variables: age, gender, age at the time of tracheostomy, primary indication for tracheostomy, length of stay in intensive care unit before and after tracheostomy, complications, mortality and cause of death. The primary indication for tracheostomy was categorized into 4 separate groups: congenital disease, traumatic injury, prolonged intubation and other causes. The study group consisted of 138 children. Seventy-one (51.4%) of the children were male, 67 (48.6%) were female and the mean age of tracheostomy was 13.30 (0.03-192.27) months, and 44.2% were younger than 1 year when tracheotomy was performed. The median age at the time of tracheostomy was highest in children who underwent tracheostomy for traumatic injury. The indication for tracheostomy was prolonged intubation in 73.2% of the children. Complications were observed in 13 (9%) children; bleeding (69.2%) was the most common. Complications were most frequent in children who underwent tracheostomy for prolonged intubation. The overall mortality ratewas 30.4% with cardiac arrest being the most common cause. At our center, the most common indication for tracheostomy in children was long-term intubation, possibly due to our center being a tertiary healthcare institute. Bleeding was the most common complication, while cardiac arrest was the most common cause of death.
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Affiliation(s)
- Ahmet Yukkaldıran
- Department of Otorhinolaryngology, Sanliurfa Training and Research Hospital, Sanliurfa, Turkey
| | - Ahmet Doblan
- Department of Otorhinolaryngology, SBÜ Mehmet Akif İnan Training and Research Hospital, Sanliurfa, Turkey
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Phuaksaman C, Niyomkarn W, Somboon P, Boonjindasup W, Hantragool S, Sritippayawan S. Long-term Outcomes of Pediatric Tracheostomy Home Care in a Limited Resource Setting of Professional Home Nurse. HOME HEALTH CARE MANAGEMENT AND PRACTICE 2022. [DOI: 10.1177/10848223221082661] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Long-term outcomes of pediatric patients with a tracheostomy in developing countries where professional home nurse is not accessible has rarely been reported. We, therefore, investigated the prevalence and associating factors of long-term outcomes in these children. Retrospective chart review was conducted in 85 tracheostomized children who were discharged to home during January 2012 to December 2020. Tracheostomy home care was provided by caregivers who completed the tracheostomy home care program. Prevalence of unplanned readmission with acute respiratory problems within 30 days after the first hospital discharge was 17.6%. Lower respiratory tract infection (LRTI) after hospital discharge was found in 72.9% (median frequency of 1.0 episode/case/year). Among 80 children who had surveillance airway endoscopy, 46.3% demonstrated late tracheostomy-related airway complications. Independent factor associated with late tracheostomy-related airway complications was a follow-up period longer than 1 year. Decannulation success was found in 21.2%. Most of them had tracheostomy for their upper airway anomalies. The mortality rate was 7%. Most of them died from their underlying diseases. In conclusion, pediatric tracheostomy home care undertaken by caregivers is feasible in developing countries where home nurse is not available. The prevalence of unplanned readmission with acute respiratory problems within 30 days after hospital discharge and late tracheostomy-related airway complications were comparable with those reported in developed countries. However, we still had a high prevalence of post-tracheostomy LRTI which was a challenging problem that needed to be investigated and resolved.
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de Araujo OR, Azevedo RT, de Oliveira FRC, Colleti Junior J. Tracheostomy practices in children on mechanical ventilation: a systematic review and meta-analysis. J Pediatr (Rio J) 2022; 98:126-135. [PMID: 34509427 PMCID: PMC9432186 DOI: 10.1016/j.jped.2021.07.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/25/2021] [Revised: 07/08/2021] [Accepted: 07/09/2021] [Indexed: 12/15/2022] Open
Abstract
OBJECTIVE To evaluate current practices of tracheostomy in children regarding the ideal timing of tracheostomy placement, complications, indications, mortality, and success in decannulation. SOURCE OF DATA The authors searched PubMed, Embase, Cochrane Library, Google Scholar, and complemented by manual search. The guidelines of PRISMA and MOOSE were applied. The quality of the included studies was evaluated with the Newcastle-Ottawa Scale. Information extracted included patients' characteristics, outcomes, time to tracheostomy, and associated complications. Odds ratios (ORs) with 95% CIs were computed using the Mantel-Haenszel method. SYNTHESIS OF DATA Sixty-six articles were included in the qualitative analysis, and 8 were included in the meta-analysis about timing for tracheostomy placement. The risk ratio for "death in hospital outcome" did not show any benefit from performing a tracheostomy before or after 14 days of mechanical ventilation (p = 0.49). The early tracheostomy before 14 days had a great impact on the days of mechanical ventilation (-26 days in mean difference, p < 0.00001). The authors also found a great reduction in hospital length of stay (-31.4 days, p < 0.008). For the days in PICU, the mean reduction was of 14.7 days (p < 0.007). CONCLUSIONS The meta-analysis suggests that tracheostomy performed in the first 14 days of ventilation can reduce the time spent on the ventilator, and the length of stay in the hospital, with no effect on mortality. The decision to perform a tracheostomy early or late may be more dependent on the baseline disease than on the time spent on ventilation .
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Affiliation(s)
| | | | - Felipe Rezende Caino de Oliveira
- Instituto de Oncologia Pediátrica de São Paulo - GRAACC, São Paulo, SP, Brazil; Hospital Alvorada Moema, Departamento de Pediatria, São Paulo, SP, Brazil
| | - José Colleti Junior
- Hospital Alvorada Moema, Departamento de Pediatria, São Paulo, SP, Brazil; Hospital Assunção Rede D'Or São Luiz, Departamento de Pediatria, São Bernardo do Campo, SP, Brazil.
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Veder LL, Joosten KFM, Zondag MD, Pullens B. Indications and clinical outcome in pediatric tracheostomy: Lessons learned. Int J Pediatr Otorhinolaryngol 2021; 151:110927. [PMID: 34592656 DOI: 10.1016/j.ijporl.2021.110927] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/03/2021] [Revised: 07/13/2021] [Accepted: 09/18/2021] [Indexed: 11/25/2022]
Abstract
OBJECTIVE Indications for tracheostomy have changed over the last decades and clinical outcome varies depending on the indication for tracheostomy. By gaining more insight in the characteristics and outcome of the tracheostomized pediatric population, clinical care can be improved and a better individual prognosis can be given. Therefore, we studied the outcome of our pediatric tracheostomy population in relation to the primary indication over the last 16 years. METHODS We retrospectively included children younger than 18 years of age with a tracheostomy tube in the Erasmus Medical Center, Sophia children's hospital. The primary indication for tracheostomy, gender, age at tracheostomy, age at decannulation, comorbidity, mortality, closure of a persisting tracheocutaneous fistula after decannulation, surgery prior to decannulation and the use of polysomnography were recorded and analyzed. RESULTS Our research group consisted of 225 children. Reasons for a tracheostomy were first divided in two major diagnostic groups: 1) airway obstruction group (subgroups: laryngotracheal obstruction and craniofacial anomalies) and 2) pulmonary support group (subgroups: cardio-pulmonary diseases and neurological diseases). Children in the airway obstruction group were younger when receiving a tracheostomy (3.0 months vs. 31.0 months, p < 0.05), they were tracheostomy dependent for a longer time (median 21.5 months vs. 2.0 months, p < 0.05) and they required surgery more often (74.5% vs. 8.3%, p < 0.05) than the children in the pulmonary support group. The decannulation rate of children with a laryngotracheal obstruction is high (74.8%), but low in all other subgroups (craniofacial anomalies; 38.5%, cardio-pulmonary diseases; 34.6% and neurological diseases; 52.9%). Significantly more children (36.7%) died in the pulmonary support group due to underlying comorbidity, mainly in the cardio-pulmonary diseases subgroup. Surgery for a persisting tracheocutaneous fistula was performed in 34 (37.8%) children, with a significant relationship between the duration of the tracheostomy and the persistence of a tracheocutaneous fistula. No cannula related death occurred during this study period. CONCLUSION Main indications for a tracheostomy were airway obstruction and pulmonary support. Children in the airway obstruction group were younger when receiving a tracheostomy and they were tracheostomy dependent for a longer period. Within the airway obstruction group, the decannulation rate for children with laryngotracheal stenosis was high, but low for children with craniofacial anomalies. In the pulmonary support group, the decannulation rate was low and the mortality rate was high. Surgery for a persisting tracheocutaneous fistula was frequently needed.
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Affiliation(s)
- L L Veder
- Department of Otorhinolaryngology and Head and Neck Surgery, Erasmus Medical Center, Sophia Children's Hospital, Rotterdam, the Netherlands.
| | - K F M Joosten
- Department of Pediatric Intensive Care, Erasmus Medical Center, Sophia Children's Hospital, Rotterdam, the Netherlands
| | - M D Zondag
- Department of Pediatric Intensive Care, Erasmus Medical Center, Sophia Children's Hospital, Rotterdam, the Netherlands
| | - B Pullens
- Department of Otorhinolaryngology and Head and Neck Surgery, Erasmus Medical Center, Sophia Children's Hospital, Rotterdam, the Netherlands
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Walsh A, Furlong M, Mc Nally P, O'Reilly R, Javadpour S, Cox DW. Pediatric invasive long-term ventilation-A 10-year review. Pediatr Pulmonol 2021; 56:3410-3416. [PMID: 34357690 DOI: 10.1002/ppul.25618] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2021] [Revised: 07/20/2021] [Accepted: 08/04/2021] [Indexed: 11/06/2022]
Abstract
INTRODUCTION The number of children with complex physical and developmental pathologies, including chronic respiratory insufficiency, surviving and growing beyond early childhood continues to rise. No study has examined the clinical pathway of children on invasive long-term mechanical ventilation (LTMV) in an Irish setting. Our data over a 10-year period were reviewed to see if our demographics and outcomes are in line with global trends. METHODS Children's Health Ireland (CHI) at Crumlin, Dublin is Ireland's largest tertiary pediatric hospital. A retrospective review analyzed data from children in our center commenced on LTMV via a tracheostomy over 10 years (2009-2018). This data was subdivided into two epochs for statistical analysis of longitudinal trends. RESULTS Forty-six children were commenced on LTMV from 2009 to 2018. Many had complex medical diagnoses with associated comorbidities. Far less children, 30.4% (n = 14) commenced LTMV in the latter half of the 10-year period, they also fared better in all aspects of their treatment course. Focusing solely on children who have needed LTMV over this timeframe we have been able to isolate trends specific to this cohort. Less patients commenced LTMV on a year-on-year basis, and for those that require tracheostomy and LTMV, their journey to decannulation tends to be shorter. CONCLUSION Over the period reviewed, less patients over time necessitated LTMV, and those patients are being weaned and decannulated with ever more success. This has implications in terms of predicting numbers transitioning to adult services and allocation of hospital and community care resources.
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Affiliation(s)
- Aoibhinn Walsh
- Department of Respiratory Medicine, Children's Health Ireland at Crumlin, Dublin, Ireland
| | - Mairead Furlong
- Department of Respiratory Medicine, Children's Health Ireland at Crumlin, Dublin, Ireland
| | - Paul Mc Nally
- Department of Respiratory Medicine, Children's Health Ireland at Crumlin, Dublin, Ireland.,Department of Paediatrics, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Ruth O'Reilly
- Department of Respiratory Medicine, Children's Health Ireland at Crumlin, Dublin, Ireland
| | - Sheila Javadpour
- Department of Respiratory Medicine, Children's Health Ireland at Crumlin, Dublin, Ireland
| | - Desmond W Cox
- Department of Respiratory Medicine, Children's Health Ireland at Crumlin, Dublin, Ireland.,School of Medicine, University College Dublin, Dublin, Ireland
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Chandran A, Sikka K, Thakar A, Lodha R, Irugu DVK, Kumar R, Sharma SC. The impact of pediatric tracheostomy on the quality of life of caregivers. Int J Pediatr Otorhinolaryngol 2021; 149:110854. [PMID: 34352673 DOI: 10.1016/j.ijporl.2021.110854] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2020] [Revised: 07/01/2021] [Accepted: 07/22/2021] [Indexed: 11/25/2022]
Abstract
OBJECTIVE Pediatric tracheostomy is a challenge in otolaryngology practice and it is associated with greater morbidity and mortality than in adults; hence, constant vigilance by the designated family caregiver is critical. This study was designed to assess the impact of on quality of life of caregivers in a homecare setting as a result of the presence of child with a tracheostomy. METHODS This was a combined retrospective and prospective cohort study with caregivers of children younger than 16 years who had undergone a tracheostomy, had been discharged home with a tracheostomy tube and completed 6 months of domiciliary tracheostomy care. The consenting primary caregivers were assessed for their quality of life based on the PedsQL v 4.0 questionnaires across various domains. RESULTS We identified the primary caregivers of 85 children who had undergone a tracheostomy during the study period. The children's median age was 3.5 years (range, 9 months to 14 years). The mean caregiver health-related quality of life (HRQOL) score was 59.3, the mean family functioning score was 62.8, and the mean total family impact score was 54.7 with relative deficits seen in caregiver's social functioning (56.9) and emotional functioning (53.2). Good or average quality of physical and social function was seen among 74 % and 65 % of caregivers respectively while only 55 % were reported having good or average emotional function. Emotional disturbance, interfering with everyday family activities, and sleep disturbance were the major concerns among caregivers. CONCLUSION The biopsychosocial consequences of caring for a child with a tracheostomy are profound for the family, affecting the quality of life of caregivers and adding to the emotional and social burden of the child's family.
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Affiliation(s)
- Aswin Chandran
- Department of Otolaryngology, Head & Neck Surgery, All India Institute of Medical Sciences, New Delhi, India
| | - Kapil Sikka
- Department of Otolaryngology, Head & Neck Surgery, All India Institute of Medical Sciences, New Delhi, India.
| | - Alok Thakar
- Department of Otolaryngology, Head & Neck Surgery, All India Institute of Medical Sciences, New Delhi, India
| | - Rakesh Lodha
- Department of Pediatrics, All India Institute of Medical Sciences, New Delhi, India
| | - D V K Irugu
- Department of Otolaryngology, Head & Neck Surgery, All India Institute of Medical Sciences, New Delhi, India
| | - Rakesh Kumar
- Department of Otolaryngology, Head & Neck Surgery, All India Institute of Medical Sciences, New Delhi, India
| | - Suresh C Sharma
- Department of Otolaryngology, Head & Neck Surgery, All India Institute of Medical Sciences, New Delhi, India
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12
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Jain MK, Patnaik S, Sahoo B, Mishra R, Behera JR. Tracheostomy in Pediatric Intensive Care Unit: Experience from Eastern India. Indian J Pediatr 2021; 88:445-449. [PMID: 33051785 PMCID: PMC7553802 DOI: 10.1007/s12098-020-03514-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2020] [Accepted: 09/24/2020] [Indexed: 11/30/2022]
Abstract
OBJECTIVE Tracheostomy is one of the most commonly used surgical intervention in sick children in the intensive care unit. The literature in the pediatric population is limited, therefore, we conducted this study to evaluate the indications, timing, complications, and outcomes of tracheostomy among the children at our center. METHODS This retrospective study was conducted from January 2016 through December 2019. Data was collected from the patients' records and analyzed. RESULTS During this study period, 283 children were ventilated, of which 26 (9.1%) required tracheostomy. Among this 73% were boys. The median age of the children who underwent tracheostomy was 6.32 y. The most common indication for tracheostomy was prolonged mechanical ventilation [24 cases (92%)] followed by upper airway obstruction [2 cases (8%)]. The average time of tracheostomy was 11.65 d, range (1-21 d). Complications were seen in 14 patients (55%). The most common complications were accidental decannulation, occlusion, pneumothorax, and granulation tissue. Twenty one (80%) patients were successfully discharged, out of which 16 (61%) patients were discharged after decannulation and 5 (21%) were sent home with a tracheostomy tube in situ. Overall mortality in present study was 11.5%; none was directly related to tracheostomy. CONCLUSIONS The indication for tracheostomy has been changed from emergency to more elective one. Prolonged mechanical ventilation is the most common indication for tracheostomy. Although the timing of tracheostomy is not fixed, two weeks time is reasonable and it can be done safely at the bedside in pediatric intensive care.
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Affiliation(s)
- Mukesh Kumar Jain
- Department of Pediatrics, Kalinga Institute of Medical Sciences, KIIT University, Bhubaneswar, Odisha, 751024, India.
| | - Sibabratta Patnaik
- Department of Pediatrics, Kalinga Institute of Medical Sciences, KIIT University, Bhubaneswar, Odisha, 751024, India
| | - Bandya Sahoo
- Department of Pediatrics, Kalinga Institute of Medical Sciences, KIIT University, Bhubaneswar, Odisha, 751024, India
| | - Reshmi Mishra
- Department of Pediatrics, Kalinga Institute of Medical Sciences, KIIT University, Bhubaneswar, Odisha, 751024, India
| | - Jyoti Ranjan Behera
- Department of Pediatrics, Kalinga Institute of Medical Sciences, KIIT University, Bhubaneswar, Odisha, 751024, India
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13
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Alrabiah A, Alhussinan K, Alyousef M, Alsayed A, Aljasser A, Alduraywish S, Alammar A. Microbiological profiles of tracheostomy patients: a single-center experience. Multidiscip Respir Med 2021; 16:811. [PMID: 35070294 PMCID: PMC8743611 DOI: 10.4081/mrm.2021.811] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2021] [Accepted: 11/22/2021] [Indexed: 11/26/2022] Open
Abstract
Background This study compared the prevalence of common microorganisms in obstructed and non-obstructed cases across the four quarters on the first post-tracheostomy year. Methods A retrospective chart review of the microbiological profiles of all adult patients who underwent a tracheostomy was conducted between June 2015 and September 2019 at our hospital. Based on the tracheostomy indications, patients were allocated to obstructed or non-obstructed group. Any patient with at least one positive sample was followed up quarterly for a year. The first culture result obtained was recorded at least one month following the last antibiotic dose in each quarter. Results Out of the 65 tracheal aspirate results obtained from 58 patients (mean age, 57.5±16.48 years), the most common procedure and indications were surgical tracheostomy (72.4%) and non-obstructed causes (74.1%), respectively. Moreover, 47.7% of the culture results indicated Pseudomonas aeruginosa, which showed significantly different proportions across the quarters (p=0.006). Among obstructed patients, P. aeruginosa was the most common (35%), followed by methicillin-resistant Staphylococcus aureus (MRSA; 23.5%). Conclusions The most common post-tracheostomy microorganism was P. aeruginosa. MRSA showed a strong association with tracheostomy for obstructive indications.
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Affiliation(s)
- Abdulaziz Alrabiah
- Department of Otolaryngology-Head & Neck Surgery, King Saud University Medical City, College of Medicine, King Saud University, Riyadh.,Department of Otolaryngology-Head & Neck Surgery, Prince Sultan Military Medical City, Riyadh
| | - Khaled Alhussinan
- King Saud University, College of Medicine, King Saud University Medical City, Riyadh
| | - Mohammed Alyousef
- King Saud University, College of Medicine, King Saud University Medical City, Riyadh
| | - Ahmed Alsayed
- Department of Otolaryngology-Head & Neck Surgery, King Saud University Medical City, College of Medicine, King Saud University, Riyadh
| | - Abdullah Aljasser
- Department of Otolaryngology-Head & Neck Surgery, King Saud University Medical City, College of Medicine, King Saud University, Riyadh
| | - Shatha Alduraywish
- Department of Family and Community Medicine, Prince Sattam bin Abdulaziz Research Chair for Epidemiology and Public Health, College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Ahmed Alammar
- Department of Otolaryngology-Head & Neck Surgery, King Saud University Medical City, College of Medicine, King Saud University, Riyadh
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14
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Lubianca Neto JF, Castagno OC, Schuster AK. Complications of tracheostomy in children: a systematic review. Braz J Otorhinolaryngol 2020; 88:882-890. [PMID: 33472759 PMCID: PMC9615521 DOI: 10.1016/j.bjorl.2020.12.006] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2020] [Revised: 12/03/2020] [Accepted: 12/06/2020] [Indexed: 11/30/2022] Open
Abstract
Introduction Tracheostomy is a procedure that can be associated with several well-described complications in the literature, which can be divided into transoperative, early postoperative and late postoperative. When performed in children, these risks are more common than in adults. Objective To perform a systematic review of complications, including deaths, in tracheostomized pediatric patients. Methods A search was carried out for articles in the Latin American and Caribbean Health Sciences Literature and PubMed databases. Cohort studies and series reports were selected, in addition to systematic reviews, published between January 1978 and June 2020, with patients up to 18 years old, and written in English, Spanish or Portuguese. Results 1560 articles were found, of which 49 were included in this review. The average complication rate was 40%, which showed an association with age, birth weight, prematurity, comorbidities, and emergency procedures. The most common complications were cutaneous lesions and granulomas. Mortality related to the procedure reached up to 6% in children and was mainly related to cannula obstruction or accidental decannulation. Conclusion Pediatric tracheostomy is associated with several complications. The tracheostomy-related mortality rate is low, but the overall mortality of tracheostomized patients is not negligible.
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Affiliation(s)
- José Faibes Lubianca Neto
- Universidade Federal de Ciências da Saúde de Porto Alegre (UFCSPA), Disciplina de Otorrinolaringologia (ORL) e Programa de Pós-Graduação em Pediatria, Porto Alegre, RS, Brazil; Hospital da Criança Santo Antônio, Serviço de ORL Pediátrica, Programa Programa de Fellowship em ORL Pediátrica Otorrinolaringologia Pediátrica, Porto Alegre, RS, Brazil; Santa Casa de Misericórdia de Porto Alegre (UFCSPA), Serviço de ORL, Programa de Residência Médica em Otorrinolaringologia, Porto Alegre, RS, Brazil.
| | - Octavia Carvalhal Castagno
- Hospital da Criança Santo Antônio, Serviço de ORL Pediátrica, Programa Programa de Fellowship em ORL Pediátrica Otorrinolaringologia Pediátrica, Porto Alegre, RS, Brazil
| | - Artur Koerig Schuster
- Santa Casa de Misericórdia de Porto Alegre (UFCSPA), Serviço de ORL, Programa de Residência Médica em Otorrinolaringologia, Porto Alegre, RS, Brazil
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15
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Ishaque S, Haque A, Qazi SH, Mallick H, Nasir S. Elective Tracheostomy in Critically Ill Children: A 10-Year Single-Center Experience From a Lower-Middle Income Country. Cureus 2020; 12:e9080. [PMID: 32789032 PMCID: PMC7416984 DOI: 10.7759/cureus.9080] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Objective Tracheostomy is a commonly performed procedure amongst critically ill patients, especially in cases of prolonged mechanical ventilation (PMV). This study aimed to describe the indications, clinical characteristics, and outcomes of elective pediatric tracheostomies in critically ill children at our center. Methods A retrospective review of medical records of children who underwent elective tracheostomies in our pediatric intensive care unit (PICU) was conducted from January 2009 to June 2018. Data were extracted based on demographics, indications of tracheostomy, and patient outcomes. Results were reported as mean with standard deviation and as frequencies with percentage. Results Of the 3,200 patients admitted to the PICU during the study period, 1,130 were intubated. A total of 48 (4.2% of 1,130) children underwent an elective tracheostomy. 30/48 (62.5%) children had an early tracheostomy. 34/48 (71%) patients were males. Approximately 25% of our patients undergoing a tracheostomy had an underlying neurological condition as the primary diagnosis, followed by respiratory conditions (23%). The most common indications for elective tracheostomy were PMV (>7 days) (n=24, 50%) and extubation failure (n=9, 18.7%). Early tracheostomy (<14 days) had better patient outcomes in terms of ventilator-free days (8.57±4.64 in early tracheostomy vs. 6.38±6.17 days in late tracheostomy, P=0.04). The sedation-free days and ICU-free days were also significantly increased in the early tracheostomy group than in the late tracheostomy group. The successful weaning and ICU discharge rate were significantly higher in the early tracheostomy group than in the late tracheostomy group (78.1% vs. 59.7%, P<0.05; and 69.2% vs. 49.5%, P<0.05, respectively). Ventilator-associated pneumonia was more common in the late tracheostomy group (n= 14, 77%), compared to early tracheostomy group (n=12, 40%) (P=0.03). Two patients expired from tracheostomy-related complications. Conclusion PMV was the most common indication for an elective tracheostomy. Early tracheostomy is associated with improved patient outcomes; therefore, a standardized approach toward mechanically ventilated children is recommended.
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Affiliation(s)
- Sidra Ishaque
- Pediatrics, The Aga Khan University Hospital, Karachi, PAK
| | - Anwar Haque
- Pediatrics, The Indus Hospital, Karachi, PAK
| | - Saqib H Qazi
- Pediatric Surgery, The Aga Khan University, Karachi, PAK
| | - Hamdan Mallick
- Medicine, The Aga Khan University Hospital, Karachi, PAK
| | - Saad Nasir
- Internal Medicine, United Medical and Dental College, Creek General Hospital, Karachi, PAK
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16
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Sekioka A, Fukumoto K, Miyake H, Nakaya K, Nomura A, Yamada S, Kanai R, Urushihara N. Long-Term Outcomes After Pediatric Tracheostomy-Candidates for and Timing of Decannulation. J Surg Res 2020; 255:216-223. [PMID: 32563762 DOI: 10.1016/j.jss.2020.05.061] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2020] [Revised: 05/07/2020] [Accepted: 05/18/2020] [Indexed: 11/30/2022]
Abstract
BACKGROUND Although pediatric tracheostomy has been a widely performed, life-saving procedure, its long-term outcomes have remained unclear. This study aimed to review outcomes after tracheostomy at a Japanese tertiary hospital and clarify candidates for and timing of decannulation. MATERIALS AND METHODS Hospital records of critically ill children who underwent tracheostomy from 2001 to 2014 were retrospectively reviewed, subsequently analyzing outcomes according to demographics, complications, and decannulation. After excluding those who were lost to follow-up or had irreversible neuromuscular impairment, the remaining patients were divided into the decannulation (D group) and nondecannulation (ND group) groups and compared. RESULTS In total, 184 patients who underwent tracheostomy were analyzed (median age at operation: 0.5 y). The major indication for tracheostomy was irreversible neuromuscular impairment (46%). Surgery-related and overall mortality rates were 1% and 25%, respectively, while the successful decannulation rate was 21%. No significant difference in surgical indications or comorbidities was observed between the D (n = 39) and ND (n = 50) groups, except for infection (7 in D group versus 0 in ND group; P = 0.002) and chromosome-gene disorder (15% versus 34%; P = 0.04). The ND group had a significantly higher mortality rate than the D group (46% versus 3%; P < 0.0001). The median time to decannulation was 3.6 years, while that for infection was 0.7 y. CONCLUSIONS Patients who underwent tracheostomy at our institution due to temporary infections achieved more successful and earlier decannulation compared to other indications. Chromosome-gene disorder as a comorbidity can negatively affect decannulation.
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Affiliation(s)
- Akinori Sekioka
- Department of Pediatric Surgery, Shizuoka Children's Hospital, Shizuoka, Japan.
| | - Koji Fukumoto
- Department of Pediatric Surgery, Shizuoka Children's Hospital, Shizuoka, Japan
| | - Hiromu Miyake
- Department of Pediatric Surgery, Shizuoka Children's Hospital, Shizuoka, Japan
| | - Kengo Nakaya
- Department of Pediatric Surgery, Shizuoka Children's Hospital, Shizuoka, Japan
| | - Akiyoshi Nomura
- Department of Pediatric Surgery, Shizuoka Children's Hospital, Shizuoka, Japan
| | - Susumu Yamada
- Department of Pediatric Surgery, Shizuoka Children's Hospital, Shizuoka, Japan
| | - Risa Kanai
- Department of Pediatric Surgery, Shizuoka Children's Hospital, Shizuoka, Japan
| | - Naoto Urushihara
- Department of Pediatric Surgery, Shizuoka Children's Hospital, Shizuoka, Japan
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17
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Bergeron Gallant K, Sauthier M, Kawaguchi A, Essouri S, Quintal MC, Emeriaud G, Jouvet P. Tracheostomy, respiratory support, and developmental outcomes in neonates with severe lung diseases: Retrospective study in one center. Arch Pediatr 2020; 27:270-274. [PMID: 32280047 DOI: 10.1016/j.arcped.2020.03.011] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2019] [Revised: 12/27/2019] [Accepted: 03/28/2020] [Indexed: 11/17/2022]
Abstract
OBJECTIVES Pediatric tracheostomy has evolved significantly in the past few decades and the optimal timing to perform it in children with respiratory assistance is still debated. The objective of this study was to describe the indications, timing, complications, and outcomes of infants on respiratory support who had a tracheostomy in a tertiary pediatric intensive care unit (PICU). METHODS All children younger than 18 months of corrected age requiring respiratory support for at least 1 week and who had a tracheostomy between January 2005 and December 2015 were included. Their demographic and clinical data and their outcomes at 24 months of corrected age were collected and analyzed after approval from the CHU Sainte-Justine ethics committee. RESULTS During the study period, 18 children (14 preterm infants, 4 polymalformative syndromes, and 2 diaphragmatic hernias) were included. The median corrected age at tracheostomy was 97 days (0-289 days) and 94.4% were elective. The indications for tracheostomy were ventilation for more than 7 days with (61.1%) or without (38.9%) orolaryngotracheal anomaly. The median number of consultants involved per patient was 16 consultants (10-23 consultants). The median hospital length of stay was 122 days (8-365 days) before tracheostomy and 235 days (22-891 days) after tracheostomy. The median invasive ventilation time was 68 days (8-168 days) before tracheostomy and 64 days (5-982 days) after tracheostomy. In terms of complications, there were nine cases of tracheitis and five cases of tracheal granulomas. At 24 months of corrected age, 17 of 18 children survived, one of/17 was still hospitalized, three of 17 were decannulated, three of 17 received respiratory support via their tracheostomy, 11 of 17 were fed with a gastrostomy, and all had neurodevelopmental delay. CONCLUSION Tracheostomy in infants requiring at least 1 week of ventilation is performed for complex cases and is favored for orolaryngotracheal anomalies. Clinicians should anticipate the need for developmental care in this population.
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Affiliation(s)
- K Bergeron Gallant
- Pediatric Intensive Care Unit, CHU Sainte-Justine, Montreal, Canada; University of Montreal, Montreal, Canada
| | - M Sauthier
- Pediatric Intensive Care Unit, CHU Sainte-Justine, Montreal, Canada; University of Montreal, Montreal, Canada
| | - A Kawaguchi
- Pediatric Intensive Care Unit, CHU Sainte-Justine, Montreal, Canada; University of Montreal, Montreal, Canada; University of Ottawa, Children's Hospital of Eastern Ontario, Ottawa, Canada
| | - S Essouri
- Pediatric Intensive Care Unit, CHU Sainte-Justine, Montreal, Canada; University of Montreal, Montreal, Canada
| | - M C Quintal
- Pediatric Intensive Care Unit, CHU Sainte-Justine, Montreal, Canada; University of Montreal, Montreal, Canada
| | - G Emeriaud
- Pediatric Intensive Care Unit, CHU Sainte-Justine, Montreal, Canada; University of Montreal, Montreal, Canada
| | - P Jouvet
- Pediatric Intensive Care Unit, CHU Sainte-Justine, Montreal, Canada; University of Montreal, Montreal, Canada.
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18
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Factors influencing time-dependent decannulation after pediatric tracheostomy according to the Kaplan–Meier method. Eur Arch Otorhinolaryngol 2020; 277:1139-1147. [DOI: 10.1007/s00405-020-05827-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2019] [Accepted: 01/22/2020] [Indexed: 11/25/2022]
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19
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Abstract
Over the last few decades, greater numbers of tracheostomies have been performed in medically complex and fragile children to manage upper airway obstruction, progressive neuromuscular disorders, abnormal ventilatory drive and to facilitate airway clearance. The optimal timing of tracheostomy tube placement and methods to determine suitable patients for the procedure remain unclear. Caring for children with tracheostomies can have a considerable financial and psychosocial impact on a family. Pediatric patients with tracheostomies have a 2-3 fold greater morbidity and mortality compared to adult patients. Clinicians should provide as much clarity as possible for families on the positive and negative aspects of pediatric tracheotomies and long term mechanical ventilation prior to tracheostomy placement. Tracheostomies are often placed as a bridge, whilst time for healing, growth and other therapies are needed to help overcome the indication for tracheostomy. Suitable investigations used to determine the optimal timing of decannulation remain physician and institution dependent.
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Affiliation(s)
- Frances Flanagan
- Division of Pulmonary and Respiratory Diseases, Boston Children's Hospital, 333 Longwood Avenue, Boston, 02115, USA.
| | - Fiona Healy
- Children's Health Ireland at Temple Street, Dublin 1, Ireland.
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20
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Ross E, Stephenson K. Fifteen-minute consultation: Emergency management of tracheostomy problems in children. Arch Dis Child Educ Pract Ed 2019; 104:189-194. [PMID: 30635281 DOI: 10.1136/archdischild-2018-316099] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2018] [Revised: 09/28/2018] [Accepted: 10/06/2018] [Indexed: 11/04/2022]
Abstract
It is vital for healthcare professionals to have a basic understanding of tracheostomy tubes, including their routine and emergency care. Children with tracheostomies can be encountered in all areas of paediatrics from the community to tertiary units; they can be more prone to respiratory infections and may have comorbidities that increase hospital attendance. Tracheostomy-related emergencies are associated with significant morbidity and potential mortality; however, the majority of tracheostomy-related complications are preventable.
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Affiliation(s)
- Elizabeth Ross
- ENT Department, Birmingham Women's and Children's NHS Foundation Trust, Birmingham, UK
| | - Kate Stephenson
- ENT Department, Birmingham Women's and Children's NHS Foundation Trust, Birmingham, UK
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21
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Roberts J, Powell J, Begbie J, Siou G, McLarnon C, Welch A, McKean M, Thomas M, Ebdon A, Moss S, Agbeko RS, Smith JH, Brodlie M, O'Brien C, Powell S. Pediatric tracheostomy: A large single‐center experience. Laryngoscope 2019; 130:E375-E380. [DOI: 10.1002/lary.28160] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2019] [Revised: 05/23/2019] [Accepted: 06/12/2019] [Indexed: 12/12/2022]
Affiliation(s)
- Jessica Roberts
- Institute of Cellular MedicineNewcastle University Newcastle upon Tyne United Kingdom
- Department of Paediatric OtolaryngologyGreat North Children's Hospital Newcastle upon Tyne United Kingdom
| | - Jason Powell
- Institute of Cellular MedicineNewcastle University Newcastle upon Tyne United Kingdom
- Department of Paediatric OtolaryngologyGreat North Children's Hospital Newcastle upon Tyne United Kingdom
| | - Jacob Begbie
- Department of Paediatric OtolaryngologyGreat North Children's Hospital Newcastle upon Tyne United Kingdom
| | - Gerard Siou
- Department of Paediatric OtolaryngologyGreat North Children's Hospital Newcastle upon Tyne United Kingdom
| | - Claire McLarnon
- Department of Paediatric OtolaryngologyGreat North Children's Hospital Newcastle upon Tyne United Kingdom
| | - Andrew Welch
- Department of Paediatric OtolaryngologyGreat North Children's Hospital Newcastle upon Tyne United Kingdom
| | - Michael McKean
- Department of Paediatric Respiratory MedicineGreat North Children's Hospital Newcastle upon Tyne United Kingdom
| | - Mathew Thomas
- Institute of Cellular MedicineNewcastle University Newcastle upon Tyne United Kingdom
- Department of Paediatric Respiratory MedicineGreat North Children's Hospital Newcastle upon Tyne United Kingdom
| | - Anne‐Marie Ebdon
- Department of Paediatric Respiratory MedicineGreat North Children's Hospital Newcastle upon Tyne United Kingdom
| | - Samantha Moss
- Department of Paediatric Respiratory MedicineGreat North Children's Hospital Newcastle upon Tyne United Kingdom
| | - Rachel S. Agbeko
- Institute of Cellular MedicineNewcastle University Newcastle upon Tyne United Kingdom
- Department of Paediatric Anaesthesia and Intensive CareGreat North Children's Hospital Newcastle upon Tyne United Kingdom
| | - Jonathan H. Smith
- Department of Paediatric Cardiothoracic Anaesthesia and Intensive CareFreeman Hospital Newcastle upon Tyne United Kingdom
| | - Malcolm Brodlie
- Institute of Cellular MedicineNewcastle University Newcastle upon Tyne United Kingdom
- Department of Paediatric Respiratory MedicineGreat North Children's Hospital Newcastle upon Tyne United Kingdom
| | - Christopher O'Brien
- Department of Paediatric Respiratory MedicineGreat North Children's Hospital Newcastle upon Tyne United Kingdom
| | - Steven Powell
- Department of Paediatric OtolaryngologyGreat North Children's Hospital Newcastle upon Tyne United Kingdom
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Doherty C, Neal R, English C, Cooke J, Atkinson D, Bates L, Moore J, Monks S, Bowler M, Bruce IA, Bateman N, Wyatt M, Russell J, Perkins R, McGrath BA. Multidisciplinary guidelines for the management of paediatric tracheostomy emergencies. Anaesthesia 2018; 73:1400-1417. [PMID: 30062783 DOI: 10.1111/anae.14307] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/14/2018] [Indexed: 01/09/2023]
Abstract
Temporary and permanent tracheostomies are required in children to manage actual or anticipated long-term ventilatory support, to aid secretion management or to manage fixed upper airway obstruction. Tracheostomies may be required from the first few moments of life, with the majority performed in children < 4 years of age. Although similarities with adult tracheostomies are apparent, there are key differences when managing the routine and emergency care of children with tracheostomies. The National Tracheostomy Safety Project identified the need for structured guidelines to aid multidisciplinary clinical decision making during paediatric tracheostomy emergencies. These guidelines describe the development of a bespoke emergency management algorithm and supporting resources. Our aim is to reduce the frequency, nature and severity of paediatric tracheostomy emergencies through preparation and education of staff, parents, carers and patients.
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Affiliation(s)
- C Doherty
- Department of Paediatric Anaesthesia, Manchester University NHS Foundation Trust, Manchester, UK
| | - R Neal
- Paediatric Intensive Care Medicine, Paediatrics, Birmingham Children's Hospital, Birmingham, UK
| | - C English
- Department of Paediatric ENT, Manchester University NHS Foundation Trust, Manchester, UK
| | - J Cooke
- Department of Paediatric Otolaryngology, Great Ormond Street Hospital, London, UK
| | - D Atkinson
- Department of Anaesthesia and Intensive Care Medicine, Manchester University NHS Foundation Trust, Manchester, UK
| | - L Bates
- Department of Anaesthesia and Intensive Care Medicine, Royal Bolton Hospital, Bolton, UK
| | - J Moore
- Department of Anaesthesia and Intensive Care Medicine, Manchester University NHS Foundation Trust, Manchester, UK
| | - S Monks
- Department of Anaesthesia, East Lancashire Hospitals NHS Trust, Burnley, UK
| | - M Bowler
- Department of Paediatric Anaesthesia, Manchester University NHS Foundation Trust, Manchester, UK
| | - I A Bruce
- Department of Paediatric Otolaryngology, Royal Manchester Children's Hospital, Manchester, UK
- Manchester Academic Health Science Centre, Manchester, UK
- Division of Infection, Immunity and Respiratory Medicine, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
| | - N Bateman
- Department of Paediatric Otolaryngology, Royal Manchester Children's Hospital, Manchester, UK
| | - M Wyatt
- Department of Paediatric Otolaryngology, Great Ormond Street Hospital, London, UK
| | - J Russell
- Department of Paediatric ENT, Our Lady's Children's Hospital, Dublin, Ireland
| | - R Perkins
- Department of Paediatric Anaesthesia, Manchester University NHS Foundation Trust, Manchester, UK
| | - B A McGrath
- Department of Anaesthesia and Intensive Care Medicine, Manchester University NHS Foundation Trust, Manchester, UK
- Division of Infection, Immunity and Respiratory Medicine, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
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23
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Kita JY, Hosokawa S, Suzuki K, Hakamada K, Mineta H. Quattro Flap Tracheotomy-The impact of a novel surgical technique for young infants. J Pediatr Surg 2017; 52:1371-1375. [PMID: 28499712 DOI: 10.1016/j.jpedsurg.2017.04.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2017] [Revised: 04/20/2017] [Accepted: 04/27/2017] [Indexed: 11/30/2022]
Abstract
BACKGROUND Tracheotomy for pediatric patients is a surgical procedure with greater technical difficulty and higher rates of morbidity and mortality than that in adults. We report a new technique for pediatric tracheotomy that reduces the issue of granulation and recannulation after accidental decannulation. METHODS Clinical data were retrospectively reviewed for 32 pediatric patients aged 3weeks-32months who underwent Quattro Flap Tracheotomy (QFT) at our hospital. The technique for the procedure is described and illustrated in detail. We analyzed the complications of surgery and the prognosis of patients. RESULTS Twenty-seven out of 32 pediatric tracheotomy patients were aged <12months. Overall, one patient with subglottic stenosis developed granulation and required a resection. Three patients with granulation were cured using conservative treatment. Neither pneumothorax nor accidental decannulation and failure to reinsert the cannula occurred with QFT. No tracheotomy-related deaths occurred. The overall rate of postoperative complications was lower in the study group (4/32 cases, 12.5%) than in the control group (12/32 cases, 37.5%; p=0.041). CONCLUSION QFT is a new method for pediatric tracheotomy that should be performed in younger infants. If performed appropriately, QFT may reduce the incidence of complications and death in many cases that involve persistent granulation. LEVELS OF EVIDENCE IV.
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Affiliation(s)
- Jun-Ya Kita
- Department of Otorhinolaryngology, Seirei Hamamatsu General Hospital, Hamamatsu, Japan; Department of Otorhinolaryngology/Head & Neck Surgery, Hamamatsu University School of Medicine, Hamamatsu, Japan
| | - Seiji Hosokawa
- Department of Otorhinolaryngology/Head & Neck Surgery, Hamamatsu University School of Medicine, Hamamatsu, Japan.
| | - Kastuyoshi Suzuki
- Department of Otorhinolaryngology, Seirei Hamamatsu General Hospital, Hamamatsu, Japan; Department of Otorhinolaryngology/Head & Neck Surgery, Hamamatsu University School of Medicine, Hamamatsu, Japan
| | - Katsura Hakamada
- Department of Otorhinolaryngology, Seirei Hamamatsu General Hospital, Hamamatsu, Japan; Department of Otorhinolaryngology/Head & Neck Surgery, Hamamatsu University School of Medicine, Hamamatsu, Japan
| | - Hiroyuki Mineta
- Department of Otorhinolaryngology/Head & Neck Surgery, Hamamatsu University School of Medicine, Hamamatsu, Japan
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Grønhøj C, Charabi B, Buchwald CV, Hjuler T. Indications, risk of lower airway infection, and complications to pediatric tracheotomy: report from a tertiary referral center. Acta Otolaryngol 2017; 137:868-871. [PMID: 28338364 DOI: 10.1080/00016489.2017.1295469] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
BACKGROUND Although pediatric tracheotomy is potentially life-saving, the procedure is associated with high risk of complications, and indications have changed the last decade. We report indications, complications, and lower airway infections (LAIs) to pediatric tracheotomy performed at a tertiary referral center. METHODS We identified all children (<18 years) who underwent tracheotomy at our institution during 2008-2015. A review of hospital records was performed to extract data on indication of the procedure, complications, and information on pre- and postoperative LAI. RESULTS At a median age of 8 years (range: 4 months to 17 years), a total of 69 tracheotomies were performed. Neuromuscular disease (n = 21) was the most common cause for tracheotomy. The postoperative complication rate was 22%; early complications (<30 days) occurred in four patients, and nine patients encountered late complications such as wound granulation and tracheocutaneous fistula. Children without LAI prior to tracheotomy were at increased risk of LAI from the initial 30-days following surgery (OR: 2.91, 95% CI: 1.17-7.21; p = .02). Fifty-three percent (10/19) of all LAIs following tracheotomy were caused by Staphylococcus aureus (p < .01). CONCLUSIONS Pediatric tracheotomy was associated with considerable rates of minor early and late complications and high risk of short-term LAI. The main cause leading to tracheotomy was neuromuscular disease.
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Affiliation(s)
- Christian Grønhøj
- Department of Otorhinolaryngology, Head and Neck Surgery and Audiology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Birgitte Charabi
- Department of Otorhinolaryngology, Head and Neck Surgery and Audiology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Christian von Buchwald
- Department of Otorhinolaryngology, Head and Neck Surgery and Audiology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Thomas Hjuler
- Department of Otorhinolaryngology, Head and Neck Surgery and Audiology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
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Yankasari S, Lee YS, Chang WK, Moon H, Kim J, Roh JL, Choi SH, Kim SY, Nam SY. The influence of pediatric tracheostomy on the body weight percentile of children. Int J Pediatr Otorhinolaryngol 2016; 91:49-54. [PMID: 27863641 DOI: 10.1016/j.ijporl.2016.10.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2016] [Revised: 09/10/2016] [Accepted: 10/11/2016] [Indexed: 10/20/2022]
Abstract
OBJECTIVES The purpose of this study was to evaluate the changes in body weight following tracheostomy in pediatric patients. METHODS Ninety-eight patients who underwent tracheostomy at the age of 0-6 years were enrolled. The body weight and growth percentile were measured before tracheostomy and at 1, 6, and 12 months after surgery. The body weight and growth percentile were plotted against time, which was compared with Korean growth chart curve. A Retrospective observational cohort study was performed. RESULTS The mean body weight increased gradually from 6.7 (±0.51) kg to 10.84 (±0.15) kg at 12 months post-surgery (p < 0.01). The growth percentile also increased from 24.41 (±3.18) to 40.6 (±4.10) during the follow-up period (p < 0.01). We analyzed the patients with a low growth percentile (≤50th percentile). In these patients, the mean body weight increased from 4.92 (±0.27) kg to 8.97 (±0.27) kg and the growth percentile also increased from 11.02 (±1.32) to 30.56 (±3.31) (all p < 0.01). Ventilator-independent patients also presented similar pattern of body weight and its percentile. CONCLUSIONS Body weight increased after tracheostomy that was safely performed in children requiring airway management.
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Affiliation(s)
- Shereen Yankasari
- Department of Otolaryngology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Yoon Se Lee
- Department of Otolaryngology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea.
| | - Won Kyung Chang
- Department of Pediatrics, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Hyun Moon
- Department of Otolaryngology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Jiwon Kim
- Department of Otolaryngology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Jong-Lyel Roh
- Department of Otolaryngology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Seung-Ho Choi
- Department of Otolaryngology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Sang Yoon Kim
- Department of Otolaryngology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Soon Yuhl Nam
- Department of Otolaryngology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
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Buswell C, Powell J, Powell S. Paediatric tracheostomy speaking valves: our experience of forty-two children with an adapted Passy-Muir®
speaking valve. Clin Otolaryngol 2016; 42:941-944. [DOI: 10.1111/coa.12776] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/16/2016] [Indexed: 11/28/2022]
Affiliation(s)
- C. Buswell
- Department of Paediatric Speech and Language Therapy; Great North Children's Hospital; Newcastle upon Tyne UK
| | - J. Powell
- Department of Paediatric Otolaryngology; Great North Children's Hospital; Newcastle upon Tyne UK
| | - S. Powell
- Department of Paediatric Otolaryngology; Great North Children's Hospital; Newcastle upon Tyne UK
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Schweiger C, Manica D, Becker CF, Abreu LSP, Manzini M, Sekine L, Kuhl G. Tracheostomy in children: a ten-year experience from a tertiary center in southern Brazil. Braz J Otorhinolaryngol 2016; 83:627-632. [PMID: 27599810 PMCID: PMC9449076 DOI: 10.1016/j.bjorl.2016.08.002] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2016] [Revised: 08/01/2016] [Accepted: 08/10/2016] [Indexed: 11/30/2022] Open
Abstract
INTRODUCTION Children may require tracheostomy due to many different health conditions. Over the last 40 years, indications of tracheostomy have endorsed substantial modifications. OBJECTIVE To evaluate pediatric patients warranted tracheostomy at our Hospital, in regard to their indications, associated comorbidities, complications and decannulation rates. METHODS Retrospective study concerning patients under 18 years of age undergoing tracheostomy in a tertiary health care center, from January 2006 to November 2015. RESULTS 123 children required a tracheostomy after ENT evaluation during the study period. A proportion of 63% was male, and 56% was under one year of age. Glossoptosis was the most common indication (30%), followed by subglottic stenosis (16%) and pharyngomalacia (11%). The mortality rate was 31%. By the end of this review, 35 children (28.4%) had been decannulated, and the fewer the number of comorbidities, the greater the decannulation rate (0.77±0.84 vs. 1.7±1.00 comorbidities; p<0.001). CONCLUSION Tracheostomy in children is a relatively frequent procedure at our hospital. The most common indications are glossoptosis and subglottic stenosis. A high mortality rate was found, potentially substantiated by the high number of critical care patients with chronic neurological conditions in this cohort. Our decannulation rate is slightly below other series, probably because of the greater amount of patients with comorbidities.
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Affiliation(s)
- Cláudia Schweiger
- Hospital de Clínicas de Porto Alegre, Serviço de Otorrinolaringologia, Porto Alegre, RS, Brazil.
| | - Denise Manica
- Hospital de Clínicas de Porto Alegre, Serviço de Otorrinolaringologia, Porto Alegre, RS, Brazil
| | - Carolina Fischer Becker
- Hospital de Clínicas de Porto Alegre, Serviço de Otorrinolaringologia, Porto Alegre, RS, Brazil
| | | | - Michelle Manzini
- Hospital de Clínicas de Porto Alegre, Serviço de Otorrinolaringologia, Porto Alegre, RS, Brazil
| | - Leo Sekine
- Universidade Federal do Rio Grande do Sul (UFRGS), Programa de Pós-graduação em Epidemiologia, Porto Alegre, RS, Brazil
| | - Gabriel Kuhl
- Hospital de Clínicas de Porto Alegre, Serviço de Otorrinolaringologia, Porto Alegre, RS, Brazil; Universidade Federal do Rio Grande do Sul (UFRGS), Departamento de Oftalmologia e Otorrinolaringologia, Porto Alegre, RS, Brazil
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Gergin O, Adil EA, Kawai K, Watters K, Moritz E, Rahbar R. Indications of pediatric tracheostomy over the last 30 years: Has anything changed? Int J Pediatr Otorhinolaryngol 2016; 87:144-7. [PMID: 27368463 DOI: 10.1016/j.ijporl.2016.06.018] [Citation(s) in RCA: 55] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
IMPORTANCE Recent reports have shown that the indications for pediatric tracheostomy have evolved over time. OBJECTIVE To review the indications for pediatric tracheostomy over the last 30 years. DESIGN Retrospective chart review. SETTING Tertiary referral children's hospital. PARTICIPANTS Patients who underwent tracheostomy. INTERVENTION Surgical tracheostomy placement. MAIN OUTCOMES AND MEASURES Medical records for patients who underwent surgical tracheostomy over the 30-year study period (1984-2014) were reviewed. Patient characteristics including age, gender, birth-weight, gestational age and death were collected and compared with the primary indication for tracheostomy using bivariable analysis. RESULTS Five hundred and one patients met inclusion criteria. The most common primary indications for tracheostomy were cardiopulmonary disease (34%) and neurological impairment (32%), followed by airway obstruction (19%), craniofacial (11%), and traumatic injury (4%). Over the last five years (2010-14) cardiopulmonary disease became the most common indication for tracheostomy. CONCLUSIONS and RELEVANCE The indications for pediatric tracheostomy have evolved over the past 30 years. Infectious causes of airway obstruction and tracheostomy have almost disappeared. Tracheostomy is now most commonly performed in very premature patients with cardiopulmonary or neurological impairment who require prolonged ventilator support.
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Affiliation(s)
- Ozgul Gergin
- Department of Otolaryngology and Communication Enhancement, Boston Children's Hospital, Boston, MA, USA
| | - Eelam A Adil
- Department of Otolaryngology and Communication Enhancement, Boston Children's Hospital, Boston, MA, USA; Department of Otology and Laryngology, Harvard Medical School, Boston, MA, USA
| | - Kosuke Kawai
- Department of Otolaryngology and Communication Enhancement, Boston Children's Hospital, Boston, MA, USA; Clinical Research Center, Boston Children's Hospital, Boston, MA, USA
| | - Karen Watters
- Department of Otolaryngology and Communication Enhancement, Boston Children's Hospital, Boston, MA, USA; Department of Otology and Laryngology, Harvard Medical School, Boston, MA, USA
| | - Ethan Moritz
- Department of Otolaryngology and Communication Enhancement, Boston Children's Hospital, Boston, MA, USA
| | - Reza Rahbar
- Department of Otolaryngology and Communication Enhancement, Boston Children's Hospital, Boston, MA, USA; Department of Otology and Laryngology, Harvard Medical School, Boston, MA, USA.
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