Pediatric Tracheotomy: Comparison of surgical technique with early and late complications in 273 cases

Impact of Vertical and Horizontal Skin Incisions on Outcome Measures in Tracheostomies

Tracheostomy is a life-saving procedure in which an opening is created in the anterior wall of the trachea. Different skin incision types are administered in tracheostomy procedures, predominantly vertical and horizontal. Various literature on the skin incision types in tracheostomy had contradictory findings, with different studies observing that one skin incision type had better outcomes than its counterpart. Hence the objective of this study was to compare the outcomes associated with vertical and horizontal skin incisions in patients undergoing tracheostomy. Method The present study assessed the outcome measures between the two incision types (vertical and horizontal) in tracheostomy. A prospective longitudinal study was done based on an academic tertiary hospital in Bhopal, Madhya Pradesh. Participants above 18 years who underwent tracheostomy were enrolled in the study and followed up over six months during intraoperative, immediate, within seven days, and long-term periods. Result In intraoperative complications, bleeding was most common (n = 15, 16.7%), followed by passage of tube into false tract (n = 6, 6.7%) and saturation drop (n = 2, 2.2%). Immediate complications comprised T-tube blockage (n = 4, 4.4%) and bleeding (n = 1, 1.1%). Complications within seven days occurred only in the horizontal group in which stomal site ulceration (n = 4, 6.7%) and delayed bleeding (n = 2, 3.3%) was seen, and one participant had unintended decannulation. In the long term, complications observed were stomal granulation (n = 9, 19.1%), dysphagia (n = 7, 14.9%), and unintended decannulation (n = 4, 8.5%). Conclusion In the current study, the most common intraoperative complication was bleeding, the immediate complication was tube dislodgement, and tracheostomy site ulcer was the most common complication within seven days, similar to the literature findings.

Tracheostomy-Assisted Foreign Body Removal: Insights From a Case Series and Literature Review

BACKGROUND

Foreign body aspiration into the trachea is a common occurrence in children. While most foreign bodies in the airways can be removed using rigid tracheoscopy, there are instances where tracheostomy or tracheotomy is needed. This article presents a series of cases in which tracheostomy was necessary to remove foreign bodies, and summarizes the relevant experiences and lessons learned.

METHODS

We reviewed a total of 7 cases in which tracheostomy and rigid tracheoscopy were combined for foreign body removal out of a larger cohort of 1559 cases at Shenzhen Children's Hospital in Guangdong, China over a 20-year period.

RESULTS

The combined use of tracheostomy and rigid tracheoscopy resulted in successful removal of foreign bodies in all 7 patients reviewed in this study. Six patients developed complications of tracheotomy, mainly including mediastinal emphysema (5/7), subcutaneous emphysema (3/7), and pneumothorax (1/7). Tracheotomy was temporary in all patients.

CONCLUSION

In cases where a foreign body in the trachea is too large or has irregular, sharp edges, is embedded in submucosal tissues with edema, cannot be passed smoothly through the vocal cords, or local endoscopic facilities are inadequate, a tracheotomy may be necessary. However, this approach should be used with caution, and close collaboration with anesthesiologists and careful management of intraoperative emergencies are crucial for improving the success rate of the procedure. Additionally, the complications should be noted, paying particular attention to early complications such as pneumothorax, pneumomediastinum, and bleeding.

[Pediatric tracheotomy: clinical analysis of 95 cases with different etiology]

Objective:To disscuss the changes in indications, surgical opportunity and post-operative management of pediatric tracheotomy. Methods:Retrospective cohort study of pediatric patients undergoing tracheostomy between January 2016 and December 2020 at Children's Hospital of Fudan University. Ninety-five patients were divided into four groups according to their primary indication. Group A: neuromuscular disease（n=36, 37.9%）, Group B: congenital abnormality（n=30, 31.6%）, Group C: accidental injury（n=15, 15.8%）, Group D: tumor（n=14, 14.7%）. Results:By the comparison between four groups, children in group A had higher incidence of Severe pneumonia（47.2%）, higher usage of mechanical ventilation（97.2%）, longer hospitalization days（=84.9 days） and higher rate of Ventilator dependence（66.7%）; children in group B had higher rate of emergency surgery（4.2%）, lower age（median age 2 months） and lower usage of mechanical ventilation（30.0%）; Mortality of the children in group D was the highest（42.9%）. In the recent five years, we saw a increasing tendency in the proportion of group A（28.6%, 35.0%, 38.5%, 44.4%, 43.5%）, and a decreasing tendency of group B（57.1%, 30.0%, 38.5%, 33.3%, 21.7%）. On discharge, 50.5% of children（48 of 95）spontaneously breathe with the tracheos tomy in situ, 29.5% of children（28 of 95）had ventilator-dependence, tracheostomy decannulation was successful in 6.3% of children （6 of 95） and all-cause mortality was 13.7% （13 of 95）. Conclusion:Most paediatric tracheotomies were performed due to chronic underlying diseases. Pediatric tracheostomy should be considered as a long-term intervention in many children. Earlier tracheotomy can shorten the duration of post-tracheotomy mechanical ventilation in several conditions.

National questionnaire on skills and techniques in pediatric tracheotomy surgery in Turkey

OBJECTIVE

The aim of the study was to determine the differences in surgical preferences of ENT Surgeons in Turkey with regard to pediatric tracheotomy.

DESIGN

Questionnaire study.

PARTICIPANTS

ENT Surgeons.

MATERIALS AND METHODS

The national multiple-choice questionnaire study included a total of 16 questions about physicians technical preferences, different methods and complications in pediatric tracheotomy surgery. It was planned and implemented with the support of a professional survey company (www.surveymonkey.com).

RESULTS

The questionnaire was answered by 591 ENT Surgeons; the percentage of the physicians performing pediatric tracheotomies in the previous year was 59.6%. Forty point four percent (40.4%) of the physicians had not performed tracheotomies in the pediatric age group and 57.9% had not performed tracheotomies in patients under one year old. Seventy point six percent (70.6%) of the physicians who had performed tracheotomies had made vertical skin incisions, 69.5% of them had removed subcutaneous adipose tissue, 81.4% of them had retraction the thyroid isthmus area from their field of view; 83.9% of them had made a vertical incision to the trachea, 82.5% of them had applied a stay suture to the trachea and 4.7% of them had used additional techniques for stoma maturation. The intraoperative mortality, early complication, late complication, and total complication rates were 3.9%, 32.7%, 21.2% and 53.9 respectively.

CONCLUSIONS

This is the first large-scale questionnaire study with data on pediatric tracheotomy techniques and the practices of ENT Surgeons at a national level. Common approaches were observed among the.