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Adeyemo A, Oyelakin O. Audit of open pediatric tracheostomies at the University College Hospital, Ibadan. NIGERIAN JOURNAL OF MEDICINE 2020. [DOI: 10.4103/njm.njm_54_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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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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Bashir A, Henningfeld JK, Thompson NE, D'Andrea LA. Polysomnography Provides Useful Clinical Information in the Liberation from Respiratory Technology: A Retrospective Review. Pediatr Pulmonol 2018; 53:1549-1558. [PMID: 30350930 DOI: 10.1002/ppul.24164] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2018] [Accepted: 08/16/2018] [Indexed: 01/25/2023]
Abstract
Background The prevalence of respiratory-technology dependent children is increasing although for most children the goal is liberation from technology. Liberation from home mechanical ventilation (HMV) and decannulation strategies vary due to the lack of clinical practice standards. The primary objective of this study was to describe our practice utilizing a polysomnography (PSG) in the liberation from respiratory-technology process. Methods Retrospective study of tracheostomized children with and without HMV who underwent an evaluation for decannulation between January 2006 and June 2016. Patient demographics, indication for tracheostomy, indication for PSG, PSG results and interventions performed after the PSG were collected. RESULTS: We identified 153 decannulation attempts in 148 children. Ninety-nine children had a tracheostomy only and 49 children had a tracheostomy with HMV. There were 190 PSGs performed. Almost two-thirds of the children (N = 92) had at least one PSG, 37 children (25%) had two and 19 children (13%) had more than 2 PSGs. Children with tracheostomy and HMV had more PSGs compared to children with tracheostomy only. PSGs were performed at four points: (1) prior to tracheostomy placement (N = 23); (2) to titrate HMV (N = 19); (3) off-HMV support (N = 43); and with a capped tracheostomy (N = 101). Most of the off-HMV PSGs (N = 39) were favorable for discontinuing HMV. About two-thirds of the capped PSGs (N = 73) were favorable for decannulation; of the unfavorable capped PSGs (N = 28), thirteen required airway surgeries following the unfavorable PSG. CONCLUSION: : Overnight PSG provides useful information to the liberation process, particularly when determining readiness for discontinuing HMV and decannulation.
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Affiliation(s)
- Ahsan Bashir
- Pediatric Pulmonary and Sleep Medicine, Medical College of Wisconsin, Milwaukee, WisconsinWisconsin
| | - Jennifer K Henningfeld
- Pediatric Pulmonary and Sleep Medicine, Medical College of Wisconsin, Milwaukee, WisconsinWisconsin
| | - Nathan E Thompson
- Pediatric Critical Care Medicine, Medical College of Wisconsin, Milwaukee, WisconsinWisconsin
| | - Lynn A D'Andrea
- Pediatric Pulmonary and Sleep Medicine, Medical College of Wisconsin, Milwaukee, WisconsinWisconsin
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Revealing the needs of children with tracheostomies. Eur Ann Otorhinolaryngol Head Neck Dis 2018; 135:S93-S97. [PMID: 30193946 DOI: 10.1016/j.anorl.2018.07.007] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2018] [Revised: 07/27/2018] [Accepted: 07/27/2018] [Indexed: 10/28/2022]
Abstract
INTRODUCTION Small children with tracheostomy are at potential risk and have very specific needs. International literature describes the need for tracheostomy in 0.5% to 2% of children following intubation. Reports of children submitted to tracheostomy, their characteristics and needs are limited in developing countries and therefore there is a lack of health programs and government investment directed to medical and non-medical care of these patients. The aim of this study was to describe the characteristics of these children and identify problems related to or caused by the tracheostomy. METHODS A retrospective cohort study was performed based on a common database applied in four high complexity healthcare facilities to children submitted to tracheostomy from January 2013 to December 2015. Data concerning children's demographics, indication for tracheostomy, early and late complications related to tracheostomy, airway diagnosis, comorbidities and decannulation rates are reported. Patients who did not present a complete database or had a follow-up of less than six months were excluded. RESULTS A total of 160 children submitted to tracheostomy during the three-year period met the criteria and were enrolled in this study. Median age at tracheostomy was 6.9 months (ranging from 1 month to 16 years, interquartile range of 26 months). Post-intubation laryngitis was the most frequent indication (48.8%). Comorbidities were frequent: neurologic disorders were reported in 40%, pulmonary pathologies in 26.9% and 20% were premature infants. Syndromic children were 23.1% and the most frequent was Down's syndrome. The most common early complication was infection that occurred in 8.1%. Stomal granulomas were the most frequent late complication and occurred in 16.9%. Airway anomalies were frequently diagnosed in follow-up endoscopic evaluations. Subglottic stenosis was the most frequent airway diagnosis and occurred in 29.4% of the cases followed by laryngomalacia, suprastomal collapse and vocal cord paralysis. Decannulation was achieved in 22.5% of the cases in the three-year period. The main cause for persistent tracheostomy was the need for further treatment of airway pathology. Mortality rate was 18.1% during this period but only 1.3% were directly related to the tracheostomy, the other deaths were a consequence of other comorbidities. CONCLUSION Tracheostomies were performed mostly in very small children and comorbidities were very common. Once a tracheostomy was performed in a child in most cases it was not removed before a year. The most common early complication was stoma infection followed by accidental decannulation. The most frequent late complication was granuloma and suprastomal collapse. Airway abnormalities were very frequent in this population and therefore need to be assessed before attempting decannulation.
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Dal'Astra APL, Quirino AV, Caixêta JADS, Avelino MAG. Tracheostomy in childhood: review of the literature on complications and mortality over the last three decades. Braz J Otorhinolaryngol 2017; 83:207-214. [PMID: 27256033 PMCID: PMC9442684 DOI: 10.1016/j.bjorl.2016.04.005] [Citation(s) in RCA: 55] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2016] [Revised: 04/04/2016] [Accepted: 04/07/2016] [Indexed: 11/26/2022] Open
Abstract
INTRODUCTION Tracheostomy is a procedure with unique characteristics when used on pediatric patients due to the greater technical difficulty and higher morbidity and mortality rates relative to the procedure in adults. In recent decades, there have been significant changes in the medical care available to children, particularly for those who need intensive care. Surgical conditions have also improved, and there has been an advent of new equipment and medications. These advances have brought changes to both tracheostomy indications and tracheostomy complications. OBJECTIVE To perform a review of the articles published over the last three decades on the complications and mortality associated with tracheostomies in children. METHODS Articles were selected from the Cochrane, Latin American and Caribbean Health Sciences Literature, SciELO, National Library of Medicine (Medline Plus), and PubMed online databases. The articles selected had been published between January 1985 and December 2014, and the data was compared using the Chi-square test. RESULTS A total of 3797 articles were chosen, 47 of which were used as the basis for this review. When the three decades were evaluated as a whole, an increase in tracheostomies in male children under one year of age was found. The most common complications during the period analyzed in descending order of frequency were granuloma, infection, and obstruction of the cannula, accidental decannulation, and post-decannulation tracheocutaneous fistula. In the second and third decades of the review, granulomas represented the most common complication; in the first decade of the review, pneumothoraces were the most common. Mortality associated with tracheostomy ranged from 0% to 5.9%, while overall mortality ranged from 2.2% to 59%. In addition, the review included four studies on premature and/or very underweight infants who had undergone tracheostomies; the studies reported evidence of higher mortality in this age group to be largely associated with underlying diseases. CONCLUSION Improved surgical techniques and intensive care, the creation of new medications, and vaccines have all redefined the main complications and the mortality rates of tracheostomy in children. It is a safe procedure that increases chances of survival in those who require the prolonged use of mechanical ventilation.
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Ang AHC, Chua DYK, Pang KP, Tan HKK. Pediatric Tracheotomies in an Asian Population: The Singapore Experience. Otolaryngol Head Neck Surg 2016; 133:246-50. [PMID: 16087023 DOI: 10.1016/j.otohns.2005.03.085] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2004] [Accepted: 03/15/2005] [Indexed: 11/26/2022]
Abstract
Objective: Over the past 2 decades, tracheotomy in children and infants has evolved from a primarily emergent procedure for upper airway obstruction into a semielective procedure for airway access in assisted ventilation. We present a 12-year retrospective review of tracheotomies performed in the pediatric population in Singapore. Study Design and Setting: We reviewed all tracheotomies performed in children below the age of 16 years in 2 tertiary pediatric medical centers in Singapore from January 1991 to December 2003. Indications for surgery are reviewed, and outcomes in terms of morbidity rate, mortality rate, postoperative rehabilitation, and duration of decannulation process were analyzed. Results: Tracheotomies were performed in 48 children during the study period. The mean age of patients was 3.24 years, with ages ranging from 16 days to 14 years. Sixty-three percent of tracheotomies were done within the 1st year of life. The chief indication was airway access for assisted ventilation. The overall complication rate was 31%. There were 13 attempts at decannulation, with 9 successes. No tracheotomy-related deaths occurred. Conclusion: Tracheotomy is a relatively safe procedure in children and infants. Lower decannulation rates and the evolving role of tracheotomy for early access in assisted ventilation permits earlier discharge with tracheotomy in situ.
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Affiliation(s)
- Annette H C Ang
- Department of Otolaryngology, Kandang Kerbau Women's and Children's Hospital, Singapore, Singapore.
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García-Urabayen D, López-Fernández Y, Pilar-Orive J, Nieto-Faza M, Gil-Antón J, López-Bayón J, Redondo-Blázquez S. Analysis of tracheostomies in a Paediatric Intensive Care Unit during the period 2003–2013. ANALES DE PEDIATRÍA (ENGLISH EDITION) 2016. [DOI: 10.1016/j.anpede.2015.10.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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García-Urabayen D, López-Fernández YM, Pilar-Orive J, Nieto-Faza M, Gil-Antón J, López-Bayón J, Redondo-Blázquez S. [Analysis of tracheostomies in a pediatric intensive care unit during the period 2003-2013]. An Pediatr (Barc) 2015; 84:18-23. [PMID: 25843507 DOI: 10.1016/j.anpedi.2015.02.021] [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: 12/12/2014] [Revised: 02/18/2015] [Accepted: 02/24/2015] [Indexed: 11/25/2022] Open
Abstract
INTRODUCTION Tracheotomy in pediatric patients is a rare procedure. In this pediatric series, perioperative complications, mortality related to surgical procedure and overall mortality are analyzed. PATIENTS AND METHODS This is a retrospective study conducted from January 2003 to December 2013. Data were retrieved from patients who were tracheotomized and admitted to our PICU in the postoperative period. RESULTS Data were collected from 25 tracheotomized patients admitted during the study period. The mean age was 3.3 months (median 14 months, range 1-144 months), and PICU length of stay was 53 days (median 37 days, range 1-338 days). Most patients (68%) had comorbidities before their admission, with a higher prevalene of craniofacial anomalies/polymalformative syndromes (32%) and prematurity related disorders (12%) being obserevd. The most common etiologies related to the procedure were congenital airway obstruction (16%) and several types of spinal cord injury (16%), followed by tracheobronchomalacia (12%) and subglottic stenosis (12%). Some kind of complication was detected in 40% of patients, with accidental decannulation being the most frequent. Accidental or unexpected decannulation was present in a percentage as high as 20% of our patients, mainly in the first 24 hours after surgery. One of the patients died as a result of this. CONCLUSIONS The postoperative course of a tracheotomy is associated with a high rate of complications, some of them related to life-threatening events.
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Affiliation(s)
- D García-Urabayen
- Unidad de Cuidados Intensivos Pediatricos, Hospital Universitario de Cruces, Baracaldo, Vizcaya, España
| | - Y M López-Fernández
- Unidad de Cuidados Intensivos Pediatricos, Hospital Universitario de Cruces, Baracaldo, Vizcaya, España
| | - J Pilar-Orive
- Unidad de Cuidados Intensivos Pediatricos, Hospital Universitario de Cruces, Baracaldo, Vizcaya, España.
| | - M Nieto-Faza
- Unidad de Cuidados Intensivos Pediatricos, Hospital Universitario de Cruces, Baracaldo, Vizcaya, España
| | - J Gil-Antón
- Unidad de Cuidados Intensivos Pediatricos, Hospital Universitario de Cruces, Baracaldo, Vizcaya, España
| | - J López-Bayón
- Unidad de Cuidados Intensivos Pediatricos, Hospital Universitario de Cruces, Baracaldo, Vizcaya, España
| | - S Redondo-Blázquez
- Unidad de Cuidados Intensivos Pediatricos, Hospital Universitario de Cruces, Baracaldo, Vizcaya, España
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Abstract
OBJECTIVES Tracheostomy is a common procedure in the ICU when prolonged mechanical ventilation is expected. Although adult data show morbidity and mortality benefits over translaryngeal intubation, there is no consensus on optimal timing. In the pediatric population, there is sparse data regarding morbidities associated with duration of ventilation prior to tracheostomy. Our objective was to associate timing of tracheostomy with clinical outcomes in PICU patients. DESIGN This is a retrospective cohort study of patients undergoing tracheostomy. Patient factors and duration of ventilation prior to tracheostomy were collected on each patient. Morbidities such as ventilator-associated pneumonia, central catheter-associated bloodstream infection, and cardiopulmonary arrests were examined both pre- and posttracheostomy. ICU and total hospital length of stay as well as mortality were recorded. For data analysis regarding tracheostomy timing, patients were stratified into early and late groups using a cutoff of 14 days. SETTING The PICUs and cardiac ICUs in a quaternary-care children's hospital. PATIENTS All patients undergoing tracheostomy over a 3-year period. MEASUREMENTS AND MAIN RESULTS Seventy-three patients were analyzed with a median of 22 days of ventilation prior to tracheostomy. Patient factors associated with longer pretracheostomy ventilation included congenital heart disease and vasoactive drug use. Clinical events associated with longer pretracheostomy ventilation included bloodstream infection, ventilator-associated pneumonia, and cardiac arrest. Age, congenital heart disease, vasoactive drug use, bloodstream infection, and ventilator-associated pneumonia each independently increased pretracheostomy ventilator days. Median ICU length of stay after tracheostomy was 18 days. For each pretracheostomy ventilator day, ICU length of stay increased by 0.5 days and hospital length of stay increased by 1.9 days. For patients undergoing early tracheostomy, ICU and total hospital lengths of stay were 4 days and 4 weeks shorter, respectively. CONCLUSIONS Analysis of our results suggests that a longer duration of ventilation prior to tracheostomy is associated with increased ICU morbidities and length of stay. Early tracheostomy may have significant benefits without adversely affecting mortality.
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Ogilvie LN, Kozak JK, Chiu S, Adderley RJ, Kozak FK. Changes in pediatric tracheostomy 1982-2011: a Canadian tertiary children's hospital review. J Pediatr Surg 2014; 49:1549-53. [PMID: 25475792 DOI: 10.1016/j.jpedsurg.2014.04.014] [Citation(s) in RCA: 58] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/11/2014] [Revised: 04/28/2014] [Accepted: 04/28/2014] [Indexed: 11/26/2022]
Abstract
BACKGROUND Pediatric tracheostomy has undergone notable changes in frequency and indication over the past 30 years. This study investigates pediatric tracheostomy at British Columbia Children's Hospital (BCCH) over a 30-year period. METHODS A retrospective chart review of tracheostomy cases at BCCH from 1982 to 2011 was conducted. Charts were reviewed for demographics, date of tracheostomy, indication, complications, mortality and date of decannulation. Data from three 10-year time periods were compared using Fisher's Exact test to examine changes over time. RESULTS 251 procedures (154 males) performed on 231 patients were reviewed. Mean age at tracheostomy was 3.74 years with 48% of procedures undertaken before the age of one year. Frequency of procedure by year has generally declined into the early 2000's. Upper airway obstruction was the most common indication accounting for 33% of procedures. The rate of complication across the entire cohort was 22% with 63% of patients being decannulated. Tracheostomy related mortality occurred in 2.0% of cases reviewed. CONCLUSIONS Changes occurred in primary indications with infections indicating less procedures and neurological impairments indicating more procedures over time. Complications increased and the decannulation rate decreased over this 30-year review. Pediatric tracheostomy is considered a safe and effective procedure at BCCH.
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Affiliation(s)
- Lauren N Ogilvie
- Division of Pediatric Otolaryngology, BC Children's Hospital, Division of Otolaryngology, 4480 Oak Street, Vancouver, BC, V6H 3V4
| | - Jessica K Kozak
- Division of Pediatric Otolaryngology, BC Children's Hospital, Division of Otolaryngology, 4480 Oak Street, Vancouver, BC, V6H 3V4
| | - Simon Chiu
- Division of Pediatric Otolaryngology, BC Children's Hospital, Division of Otolaryngology, 4480 Oak Street, Vancouver, BC, V6H 3V4
| | - Robert J Adderley
- Home Tracheostomy Care and Home Ventilation Program, BC Children's Hospital, 4480 Oak Street, Vancouver, BC, V6H 3V4
| | - Frederick K Kozak
- Division of Pediatric Otolaryngology, BC Children's Hospital, Division of Otolaryngology, 4480 Oak Street, Vancouver, BC, V6H 3V4.
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Abstract
OBJECTIVE To determine the factors that predict outcome of noninvasive ventilation (NIV) in critically ill children. DESIGN Prospective observational study. SETTING Multidisciplinary pediatric intensive care unit of a university hospital in Malaysia. PATIENTS Patients admitted to the pediatric intensive care unit from July 2004 to December 2006 for respiratory support due to acute respiratory failure and those extubated from invasive mechanical ventilation. INTERVENTIONS NIV was used as an alternative means of respiratory support for all children. In patients who had prior invasive mechanical ventilation, NIV was used to facilitate extubation, or it was used after a failed extubation. The children were assigned to the nonresponders group (intubation was needed) or responders group (intubation was avoided totally or for at least 5 days). The physiologic variables were monitored before, at 6 hrs, and 24 hrs of NIV. MEASUREMENTS AND MAIN RESULTS Of 278 patients, 129 were admissions for management of acute respiratory failure and 149 patients received NIV to facilitate extubation (n = 98) or for a failed extubation (n = 48). Their median age and weight were 8.7 months (interquartile range, 3.1-33.1 months) and 5.5 kg (interquartile range, 3.3-10.8 kg), respectively. Intubation was avoided for > 5 days in 79.1% (n = 220). No significant difference in age or weight of responders and nonresponders was observed. The cardiorespiratory variables in all patients improved, but significant differences between the two groups were noted at 6 hrs and 24 hrs after NIV. CONCLUSIONS NIV was a feasible strategy of respiratory support to avoid intubation in > 75% of children in this study. A higher Pediatric Risk of Mortality II score, sepsis at initiation of NIV, an abnormal respiratory rate, and a higher requirement of Fio2 may be predictive factors of NIV failure.
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Genther DJ, Thorne MC. Utility of routine postoperative chest radiography in pediatric tracheostomy. Int J Pediatr Otorhinolaryngol 2010; 74:1397-400. [PMID: 20951445 DOI: 10.1016/j.ijporl.2010.09.017] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2010] [Revised: 09/14/2010] [Accepted: 09/14/2010] [Indexed: 11/19/2022]
Abstract
OBJECTIVES Routine chest radiography following pediatric tracheostomy is commonly performed in order to evaluate for air-tracking complications. Routine chest radiography affords disadvantages of radiation exposure and cost. The primary objective of this study was to determine the utility of routine postoperative chest radiography following tracheostomy in pediatric patients. Secondary objectives were to compare the rates of postoperative complications by various patient and surgeon characteristics. METHODS All infants and children 18 years of age or less (n=421) who underwent tracheostomy at a single tertiary-care medical center from January 2000 to April 2009 were included in the study. A combination of data obtained from billing and administrative systems and review of electronic medical records were recorded and compiled in a database for statistical analysis. RESULTS Three air-tracking complications (2 pneumothoraces and 1 pneumomediastinum) were identified in our population of 421 pediatric patients, for an incidence of 0.71% (95% CI: 0.1-2.0%). No significant relationships were found between the incidence of air-tracking complication and surgical specialty, patient age, or type of procedure (elective, urgent/emergent). CONCLUSIONS Our study identified a low rate of pneumothorax and pneumomediastinum following pediatric tracheostomy. In all three cases, the pneumothorax was suspected clinically. This finding suggests that postoperative chest radiography should be reserved for cases where there is suspicion of a complication on the basis of intraoperative findings or clinical parameters.
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Affiliation(s)
- Dane J Genther
- Department of Otolaryngology, Head and Neck Surgery, Johns Hopkins University, USA
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13
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Abstract
BACKGROUND Tracheostomy is more hazardous in the pediatric population than in adults (Paediatr Nurs, 17, 2005, 38; Int J Pediatr Otorhinolaryngol, 67, 2003, 7; J R Soc Med, 89, 1996, 188). Airway management in these children and infants is potentially challenging. Previous case series of pediatric tracheostomy published in the surgical journals make little mention of anesthetic techniques used and do not describe airway management. The aim of this study was to review the anesthetic, and in particular the airway management of children undergoing tracheostomy at Great Ormond Street Hospital (GOSH). METHODS Between September 2004 and December 2007, the ENT surgical database showed that 109 children had a surgical tracheostomy performed at GOSH. We were only able to locate the notes of 100 of these cases. The anesthetic records of these 100 patients undergoing tracheostomy were analyzed retrospectively. RESULTS Ninety-four percent (94/100) of tracheostomies were elective, and 6% (6/100) were emergency. In this study, 26% (26/100) of children were recorded as difficult to intubate. These difficult airways were managed as follows: 10/26 used a laryngeal mask airway (LMA), 5/26 were managed with facemask alone, 3/26 had fiber-optic intubation, 5/26 had surgical intubation and 2/26 were intubated with the aid of a bougie and cricoid pressure. CONCLUSIONS This case series demonstrates that intubation is difficult in up to 26% of children presenting for tracheostomy. While intubation of the trachea remains the preferred option when anesthetizing children for tracheostomy, the LMA or facemask can provide a successful airway where intubation is not possible. The use of the LMA or facemask may therefore be life saving in the unintubatable child.
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Affiliation(s)
- Fiona Wrightson
- Department of Anaesthesia, Great Ormond Street Hospital, London, UK
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Lyons MJ, Cooke J, Cochrane LA, Albert DM. Safe reliable atraumatic replacement of misplaced paediatric tracheostomy tubes. Int J Pediatr Otorhinolaryngol 2007; 71:1743-6. [PMID: 17850888 DOI: 10.1016/j.ijporl.2007.07.017] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2007] [Revised: 07/18/2007] [Accepted: 07/19/2007] [Indexed: 11/17/2022]
Abstract
OBJECTIVE Displacement of tracheostomy tubes, especially soon after insertion has a high morbidity and mortality rate. We present a safe atraumatic reliable method of tracheostomy tube replacement. SETTING Tertiary paediatric centre. MATERIALS AND METHODS The method involves using a suction catheter placed in the trachea. Its position can be confirmed by suctioning tracheal secretions. The catheter can be used to employ the Seldinger technique for replacement of the tracheostomy tube and can be used to jet ventilate the patient if there is failure to site a tube. This buys time while a surgical airway is placed. We also outline the minimum contents of the emergency box, which should be carried at all times by the carers of a child with a tracheostomy. CONCLUSIONS Use of a suction catheter is a safe reliable atraumatic way of replacing a tracheostomy tube.
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Affiliation(s)
- Marie J Lyons
- Great Ormond Street Hospital for Children, Great Ormond Street, London WC1N 3JH, United Kingdom.
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15
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Corbett HJ, Mann KS, Mitra I, Jesudason EC, Losty PD, Clarke RW. Tracheostomy--a 10-year experience from a UK pediatric surgical center. J Pediatr Surg 2007; 42:1251-4. [PMID: 17618889 DOI: 10.1016/j.jpedsurg.2007.02.017] [Citation(s) in RCA: 82] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND/PURPOSE Tracheostomy in the pediatric population is associated with significant morbidity and mortality compared to adult practice. This study highlights evolving experience from a UK children's hospital. PATIENTS AND METHODS All children undergoing tracheostomy between 1995 and 2004 were identified. Indications, complications, and outcomes were evaluated. RESULTS Complete case records were reviewed for 112 children (age range, newborn-18 years). Indications included congenital birth defects--craniofacial disorders, esophageal atresia, laryngeal cleft, cystic hygroma, vascular malformations. Acquired upper airway pathology (15.5%) and malacia (12.1%) were additional criteria. Tracheostomy was also required for long-term ventilation in patients with neuromuscular disorders (12.1%) or ventilator dependency (26.7 %). Fifty-eight (50%) tracheostomies were created in infants <1 year. One hundred and nine were elective procedures with only 7 (6%) for emergency airway management. Morbidity included wound problems (14, 14.4%), tube displacement or obstruction (14, 14.4%), tracheocutaneous fistula (6, 6.2%), and pneumothorax (4, 4.1%). There were no acute hemorrhagic complications. Two children died after accidental tube displacement/obstruction. CONCLUSION Tracheostomy at this UK center is largely undertaken as an elective procedure. Children less than 1 year form an increasing patient group. Complications may be minimized by meticulous surgical technique and ensuring a comprehensive tracheostomy care program.
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Affiliation(s)
- Harriet J Corbett
- Division of Child Health, The Royal Liverpool Children's Hospital, University of Liverpool, Eaton Road, Liverpool, L12 2AP, UK.
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Norman V, Louw B, Kritzinger A. Incidence and description of dysphagia in infants and toddlers with tracheostomies: a retrospective review. Int J Pediatr Otorhinolaryngol 2007; 71:1087-92. [PMID: 17482279 DOI: 10.1016/j.ijporl.2007.03.018] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/26/2006] [Revised: 03/26/2007] [Accepted: 03/27/2007] [Indexed: 10/23/2022]
Abstract
OBJECTIVE An increasing number of infants and toddlers with tracheostomies were identified at a large paediatric referral hospital in South Africa. They are at risk for swallowing and feeding difficulties, however, there is limited literature reporting the incidence and describing the dysphagia in this population, and no literature specific to a developing country. The purpose of this study was therefore to report the incidence and describe the dysphagia in infants and toddlers with tracheostomies at a large paediatric referral hospital in South Africa. METHOD A retrospective, descriptive review of the medical records of 80 infants and toddlers (0-3 years) with tracheostomies between 2002 and 2004 was conducted. RESULTS Eighty percent (64/80) of the participants presented with dysphagic symptoms. Oral phase dysphagia was reported in 81.25% (52/64), pharyngeal phase dysphagia in 60.9% (39/64) and oesophageal phase dysphagia in 79.7% of the dysphagic participants. CONCLUSIONS Infants and toddlers with tracheostomies are at increased risk for dysphagia. Multiple risk factors for dysphagia associated with tracheostomies, underlying medical conditions and the context of a developing country were identified in the study population.
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Affiliation(s)
- Vivienne Norman
- Department of Communication Pathology, University of Pretoria, Lynnwood Road, Brooklyn, Pretoria 0002, South Africa.
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17
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Breysem L, Smet MH. Thoracic Emergencies. Emerg Radiol 2007. [DOI: 10.1007/978-3-540-68908-9_31] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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18
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Abstract
There are hardly any controlled studies in paediatric tracheostomy care; instead, most established standards, procedures and details have been elaborated at the bedside by trial and error. Once the appropriate tube is chosen, tube care consists of tube change, fixation, management of secretions, humidification of inspired air and application of medications. The stoma requires cleaning, protection and dressing. Child care may be structured into monitoring, feeding, bathing and clothing. Preparing the home and family environment are important prerequisites for discharge from the hospital. Last but not least, the family of the child or other caregivers must undergo a structured and detailed training programme to become competent in long-term home care.
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Affiliation(s)
- Béatrice Oberwaldner
- Respiratory and Allergic Disease Division, Paediatric Department, Medical University of Graz, Auenbruggerplatz 30, A-8036 Graz, Austria.
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19
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20
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Glossopexie als Therapie der ersten Wahl bei hochgradiger Glossoptosis. Monatsschr Kinderheilkd 2004. [DOI: 10.1007/s00112-003-0832-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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21
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Whitaker IS, Koron S, Oliver DW, Jani P. Effective management of the airway in the Pierre Robin syndrome using a modified nasopharyngeal tube and pulse oximetry. Br J Oral Maxillofac Surg 2003; 41:272-4. [PMID: 12946675 DOI: 10.1016/s0266-4356(03)00100-1] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Pierre Robin syndrome is a rare condition, first described by the French stomatologist, Pierre Robin in 1923. The severity of the syndrome varies widely, and associated upper airway obstruction is the most difficult problem to overcome. We present a case in which the airway was successfully managed with a modified naso-pharyngeal tube in addition to pulse oximetry. We also present a literature review discussing management of the airway in the Pierre Robin syndrome. The simple technique presented allows earlier patient discharge with home monitoring equipment.
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Affiliation(s)
- I S Whitaker
- Department of Anatomy, University of Cambridge, Cambridge, UK.
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22
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Ilçe Z, Celayir S, Tekand GT, Murat NS, Erdoğan E, Yeker D. Tracheostomy in childhood: 20 years experience from a pediatric surgery clinic. Pediatr Int 2002; 44:306-9. [PMID: 11982902 DOI: 10.1046/j.1442-200x.2002.01554.x] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
BACKGROUND There is a limited indication for tracheostomy procedures in pediatric surgery. It is rarely applied to the pediatric patient because they can be kept intubated for a longer duration compared with adults. Problems and complications can occur after tracheostomy, even during the childhood period. PURPOSE The purpose of this study is to evaluate our experience with tracheostomy procedure. METHODS Records of 17 children treated over a 20-year period (1978-99) were reviewed retrospectively in the aspects of indication, complication and mortality. RESULTS There were 13 boys and four girls with a mean age 30.3 months (range: 1 week-13 years). Indications for tracheostomy were prolonged intubation (n = 5), subglottic stenosis (n = 3), general body trauma (n = 2), tracheomalasia (n = 2), tracheoesophageal cleft (n = 1), cervical tumor pressing trachea and larynx (n = 1), congenital myotonic dystrophy plus respiratory failure (n = 1), burn injury of trachea and esophagus (n = 1), and foreign body aspiration (n = 1). In the last decade the number of cases with tracheotomy increased due to the development of new intensive care units, the use of mechanical ventilation and the increasing number of patients needing prolonged ventilation support. In this group, tracheostomies were mainly performed electively. The overall complication rate was 29%. Mortality was 59% and there was one death related to the tracheostomy procedure. CONCLUSION Tracheostomy is a life saving procedure when performed with an appropriate indication and surgical technique. Therefore, the pediatric surgeons dealing with this procedure should be aware of the tracheostomy care problems, fatal complications and the need for reconstructive surgery. With strict indications and experience of the procedure, this should be enough effort to minimize its complications and related care problems.
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Affiliation(s)
- Zekeriya Ilçe
- Department of Paediatric Surgery, Cerrahpaşa Medical Faculty, University of Istanbul, Turkey
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23
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Abstract
Infants with high upper airway obstruction (UAO) are managed with a variety of techniques to relieve their UAO. Among these techniques, the least invasive and safest is the nasopharyngeal tube (NPT). However, the traditional NPT is not always satisfactory, and tracheostomies need to be done. We recently described a modified NPT technique that, in contrast to the traditional tube, does not add airway dead space and resistance, is easy to use, is well-tolerated, has proven highly successful, and allows the simultaneous use of oxygen nasal prongs. This modified NPT has many advantages over the traditional NPT as a temporary management of high UAO that resolves with growth of the infant. This report highlights the respiratory care of 10 infants with high UAO (Pierre Robin syndrome, Down syndrome, Goldenhar syndrome, isolated microngathia, and idiopathic hypotonia) who were managed with a modified NPT. The modified NPT described potentially reduces the need for surgical intervention to relieve high UAO in infants.
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Affiliation(s)
- A B Chang
- Department of Respiratory Medicine, Mater Misericordiae Children's Hospital, South Brisbane, Queensland, Australia
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24
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McElhinney DB, Reddy VM, Pian MS, Moore P, Hanley FL. Compression of the central airways by a dilated aorta in infants and children with congenital heart disease. Ann Thorac Surg 1999; 67:1130-6. [PMID: 10320262 DOI: 10.1016/s0003-4975(99)00064-8] [Citation(s) in RCA: 43] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
BACKGROUND Children with congenital heart disease often experience respiratory symptoms in the preoperative and perioperative periods, which can complicate their management. An uncommon but important cause of respiratory insufficiency in such children is external airway compression. METHODS We operated on 5 patients (median age, 6 months) with significant respiratory distress attributable to compression of the central airways by a dilated ascending aorta before or after repair of concomitant cardiovascular defects. Four of these patients had right aortic arch and 3 had pulmonary atresia with a ventricular septal defect and major aortopulmonary collaterals. In all patients, aortopexy was performed at the time of operation for the cardiovascular defects (n = 3) or after symptoms developed in the postoperative period (n = 2). The 3 patients in whom airway compression produced symptoms preoperatively also underwent reduction ascending aortoplasty. RESULTS Symptoms resolved immediately after operation in 3 patients, whereas symptoms persisted in the other 2 patients and tracheostomy was required. At follow-up of 20 months to 5 years, all patients are alive and well, with mild or moderate respiratory symptoms in the 2 patients who required tracheostomy, both of whom were decannulated within 13 months. CONCLUSIONS External airway compression can cause significant morbidity in patients with congenital heart defects other than vascular rings. In patients with respiratory symptoms in the context of a lesion that involves increased aortic outflow during intrauterine life and consequently, an enlarged ascending aorta, such as tetralogy of Fallot with pulmonary atresia, airway compression should be considered as a cause, especially if a right aortic arch is present or the patient also has pulmonary atresia with a ventricular septal defect and collaterals. Attempts to address this problem surgically may provide substantial relief, but increasing duration of airway compression is likely to lead to tracheal or bronchial malacia and persistent symptoms even after the compression is relieved.
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Affiliation(s)
- D B McElhinney
- Division of Cardiothoracic Surgery, University of California, San Francisco 94143-0118, USA
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25
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Abstract
Pierre Robin sequence (PRS) presents in the neonatal period with upper airway obstruction and feeding difficulties. Infants with pronounced micrognathia may fail to thrive because of chronic airway obstruction, or experience severe respiratory distress. This is potentially fatal and surgical intervention in these cases is necessary. We present our series of cases with severe PRS requiring surgical relief of their airway obstruction, and the reasons for preferring tracheostomy over glossopexy.
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Affiliation(s)
- A P Bath
- Department of Otolaryngology, Sheffield Children's Hospital, UK
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