Objective. Considering that intubation time is the primary cause of subglottic stenosis, tracheostomy is suggested in adult patients following 10-15 days. The objective of this study was to analyze the association between intubation time and stenosis in pediatric patients, as well as to establish whether there is an adequate timing for tracheostomy in order to reduce the incidence of stenosis. Materials and methods.A retrospective study (2014-2019) of tracheostomized newborns and children after an intubation period was carried out. Endoscopic findings at tracheostomy were analyzed.Results. Tracheostomy was conducted in 189 patients, 72 of whom met inclusion criteria. Mean age was 40 months (1 month -16 years). The incidence of stenosis was 21%, with a mean age of 23 months and a mean intubation time of 30 days vs. 19 days in the non-stenosis group (p= 0.02). The incidence of stenosis increased by 7% five days following intubation, reaching 20% after one month. Patients under 6 months old had greater tolerance to intubation periods without stenosis (incidence < 6% after 40 days, and median time to stenosis of 56 days vs. 24 days in patients over 6 months old).Conclusions. In patients with long intubation periods, preventive measures should be taken in order to avoid laryngotracheal injuries, and early tracheostomy should be considered.

Arch Argent Pediatr 2013;111(6):e136-e140 / e136Presentación de casos clínicos RESUMEN La estenosis subglótica es una de las causas más frecuentes de obstrucción de la vía aérea superior en los niños. Si bien puede tener un origen congénito, la mayoría de las estenosis son adquiridas. Debe pensarse en esta patología en todo niño con antecedentes de intubación, instrumentación o trauma de la vía aérea que presenta dificultad respiratoria. El diagnóstico se sospecha por la clínica, los antecedentes y la radiografía cervical, y se confirma mediante el examen endoscópico. La conducta terapéutica dependerá, entre otros factores, del grado de estenosis que se presente. Describimos nuestra experiencia con 6 pacientes que presentaban estenosis subglótica posintubación, tratados quirúrgicamente con técnica de expansión. Palabras clave: estenosis subglótica, niños, intubación endotraqueal, tratamiento quirúrgico. AbStRActSubglottic stenosis is one of the most common causes of upper airway obstruction in children. Even though it may have a congenital origin, most of them are acquired stenosis. This condition should be suspected in any child with a history of intubation, instrumentation or trauma of the airway that is having difficulty breathing. The diagnosis is suspected by clinical, history and cervical radiograph, and is confirmed by endoscopic examination. Among others factors the treatment depends on the stenosis degree. We describe our experience with 6 patients with post-intubation subglottic stenosis treated surgically with expansion technique.

Introduction Tracheostomy is one of the most frequent surgical procedures in chronically ill pediatric patients and mechanical ventilatory assistance. The most widely used technique is open; however, the percutaneous technique guided by endoscopy is becoming increasingly common. Due to the current controversy, this study presents our experience in both techniques. Methodology Retrospective and descriptive analysis was carried out of 100 patients selected between 2010 and 2017. They were divided into two groups: open tracheostomy (TA) and percutaneous tracheostomy (PT), with 50 patients each according to the technique used. The age, diagnosis, indication of tracheostomy, days of intubation, endoscopic findings, cannula size, surgical time, intraoperative complications, and definitive decannulation were analyzed. A bibliographic review was also carried out. Results and Discussion The main indication for tracheostomy in both groups was prolonged orotracheal intubation (TA group 78% and TP group 82%). Children who underwent percutaneous tracheostomy were older in age (median age of 9 years for TA group and 2.5 years for PT group). There were no significant differences regarding the days of previous intubation: 19 days for the TA group and 13 days for the TP group. Weaning was achieved before mechanical ventilation for the TP group (7 days in the TP group and 19 days in the TA group). The surgical time was almost 50% less for the TP group (TA group 80 minutes and TP group 45 minutes). There were no intraoperative complications in any group. Distant complications were more frequent in the TA group (34%). Definitive decannulation was achieved in 17 patients in the TA group (34%) and in 19 patients in the TP group (38%). The long-term follow-up was performed for 8 months by the TA group (r: 1–36 m) and 9 months by the TP group (r: 1–48 m). Conclusions Percutaneous tracheostomy is feasible in children. Simultaneous endoscopic vision is recommended for the control of complications during the procedure. At the same time it allows us to diagnose preexisting injuries. The size of the tracheostomy kit should be adjusted to the age of the patient and the size of the tracheostomy cannula to perform a safe tracheostomy.

Objective Tracheostomy is one of the most frequently performed surgical procedures in chronically ill pediatric patients and mechanical ventilatory assistance. This study presents our experience in percutaneous tracheostomy (PT) guided by endoscopy in children. Methodology A retrospective descriptive analysis was carried out in which the PT guided by endoscopy from December 2010 to October 2017 at Pediatric Surgery Service of the Hospital Italiano de Buenos Aires were considered. The variables analyzed were age, gender, basic pathology, tracheostomy indication, size of the cannula placed, surgical complications, and follow-up. At the same time, an updated bibliographical search on the subject was carried out. All the parents of the patients gave written consent. Results and Discussion A total of 50 PT guided by endoscopy were performed. The average age was 9.4 years (05–19 years). The male/female ratio was 1 (25 men, 25 women). The tracheostomy indications were prolonged orotracheal intubation (n: 41), lack of airway protection (n: 4), laryngomalacia (n: 2), difficult airway (n: 2), and laryngotracheal stenosis (n: 1). The endoscopic findings include glottic lesion, subglottic stenosis, vocal cord injury, and tracheal lesions by decubitus. There were no intraoperative complications. The average surgical time was 44 minutes (r: 10–60 min). The rate of postoperative complications was 6% (n: 3), among which were accidental decannulation, desaturation, and leakage. Distant complications such as tracheitis or granulomas occurred in 8% of patients (n: 4). The definitive decannulation was achieved in 19 patients in an average time of 15 days. Conclusions PT is feasible in children with a margin of safety comparable to tracheostomy by conventional technique. Simultaneous endoscopic vision is recommended for the control of complications during the procedure, in part because it offers firmness to the anterior wall of the trachea. At the same time it allows us to diagnose preexisting laryngotracheal lesions or anomalies. The size of the tracheostomy kit should be adjusted to the age of the patient to perform a safe tracheostomy. Due to the small diameter of the trachea and its weakness, it is not recommended by us to perform percutaneous tracheostomy in patients under 2 years of age.

Objective This study aimed to compare days of use of a tracheostomy cannula in two groups of patients: one group used a guided decannulation protocol carried out by an interdisciplinary team and the other group did not apply any protocol. Design and Population A comparative retrospective cohort study of 40 patients was carried out, of whom 20 were decannulated without a protocol (WOP) between 2008 and 2011 and in the other 20 patients, the decannulation protocol (WP) was applied by an interdisciplinary team between 2015 and 2017. Method In 2015 a guided decannulation evaluation protocol was implemented in patients successfully weaned from prolonged mechanical ventilation that consisted of three parts: (1) daily evaluation tracheotomy requirement; (2) measuring subglottic pressure, decreasing the internal diameter of the cannula and usage of phonation valve; and (3) endoscopic evaluation, occlusion test according to age, and decannulation. The main variable was days of use of tracheostomy cannula in both groups, from the day of the surgery to the day of decannulation. Results In the cohort WOP of the 38 tracheotomized children, 20 achieved decannulation. In the group WP, the first 20 children who reached decannulation were consecutively enrolled, out of a total of 24 tracheotomized patients in that period. The median age was 58 months, with IQR (21.5–138); the diagnoses of admissions for both groups were of respiratory cause 20% CI 95% (10–35), cardiovascular 15% CI 95% (7–30), neurological 17.5% CI 95% (8–33), and other 47.5% CI 95% (32–63). The surgical procedure of tracheostomy, 52.5% were percutaneous with 95% CI (37-68) while 47.5% were surgical with 95% CI (32–63). The median use of the tracheostomy cannula was 46 days with an IQR (29–144). When analyzing the days of cannulation in both cohorts, a median of 94 days WP and CI 95% (51–261) in the group WOP and a median of 33 days WP and CI 95.5% (23–44) were found, obtaining a value of Wilcoxon–Mann–Whitney p 0.0012. Conclusions The use of a decannulation protocol applied by an interdisciplinary work team showed a significant decrease in days of use of tracheostomy cannulas in pediatric patients unrelated from the respiratory assistance.