Indications, complications, and surgical techniques for pediatric tracheostomies—An update

Kremer, Bernd; Botos-Kremer, A.I.; Eckel, H. E.; Schlöndorff, G.

doi:10.1053/jpsu.2002.36184

Cited by 249 publications

(264 citation statements)

References 32 publications

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“…15,16 As a result of all of the aforementioned co-morbidities, these patients likely have less reserve as compared with other patients and therefore are less likely to tolerate respiratory complications that may occur at home such as a mucus plug or dislodgment of their artificial airway. 17 The higher rate of home mechanical ventilation in patients with cardiac surgery, although not independently associated with mortality, does mandate a much higher level of care for many of these infants and should not be dismissed as a possible contributing factor. Caregivers of patients requiring home mechanical ventilation must not only know how to care for the tracheostomy tube but also understand the complexities of how to use, maintain, and troubleshoot a mechanical ventilator.…”

Section: Discussionmentioning

confidence: 99%

Prior Cardiac Surgery Is Independently Associated With Decreased Survival Following Infant Tracheostomy

Rosner

Mastropietro

2014

Respir Care

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INTRODUCTION: Previous reports have demonstrated that prior cardiac surgery is independently associated with in-hospital mortality after infant tracheostomy. We aimed to determine whether these infants would continue to be at increased risk for death following hospital discharge. METHODS: A retrospective review was performed on subjects < 2 y of age who recovered from tracheostomy in the pediatric ICU at our institution between January 2007 and December 2011, with follow-up to December 2013. Survival to 1 y following tracheostomy was the primary outcome variable for the study. Multivariate Cox regression analysis was then performed to determine independent risk factors for death after infant tracheostomy. RESULTS: Forty-two subjects met inclusion criteria, 18 of whom had undergone prior cardiac surgery. Twenty-six subjects (62%) were alive at 1 y post-tracheostomy. Age at tracheostomy, concomitant genetic abnormalities or prematurity, and ventilator dependence at discharge were not statistically different between survivors and those who died. Subjects who died, however, were more likely to have had cardiac surgery prior to tracheostomy (11 [69%] vs 7 [27%], P ‫؍‬ .008) and had longer hospital stay (median 3.4 months [interquartile range: 2.6 -4.6] vs 2.2 months [interquartile range: 1.1-3.5], P ‫؍‬ .045). Multivariate Cox regression analysis revealed only prior cardiac surgery to be independently associated with decreased survival after tracheostomy (hazard ratio 4.7, 95% CI 1.3-16.4, P ‫؍‬ .02). CONCLUSIONS: Prior cardiac surgery is independently associated with decreased survival within 1 y following tracheostomy. Clinicians and families of infants with prior cardiac surgery in whom tracheostomy after cardiac surgery is deemed necessary should consider this risk when planning long-term care.

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Section: Discussionmentioning

confidence: 99%

Prior Cardiac Surgery Is Independently Associated With Decreased Survival Following Infant Tracheostomy

Rosner

Mastropietro

2014

Respir Care

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“…[3][4][5] Only a few studies have included wound healing in their series of tracheostomy-related complications. 6 Regardless, wounds related to pediatric tracheostomies are common. Jaryszak and colleagues 7 found a pediatric tracheostomy wound complication rate of 29%.…”

Section: Introductionmentioning

confidence: 99%

Enhanced Tracheostomy Wound Healing Using Maltodextrin and Silver Alginate Compounds in Pediatrics: A Pilot Study

et al. 2014

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BACKGROUND: Tracheostomy wounds are commonly encountered in children but rarely reported. Relatively few treatments are available or have been investigated to manage this problem. Healing times for pediatric tracheostomy wounds are often unpredictable and protracted. Recent use of maltodextrin gel (MD) and a silver alginate sponge (AG) at our institution has demonstrated expedited healing and interest in this novel treatment for tracheostomy wounds. METHODS: We conducted an 11-month retrospective review of children with wound complications following tracheostomy placement at a tertiary care facility. Wounds were evaluated and rated based upon the National Pressure Ulcer Advisory Panel staging system. Subjects identified with stage 2 or greater tracheostomy-related ulcers treated with MD and/or AG were included. Subject characteristics and wound healing rates were tabulated in a database that included age, wound site, initial and final wound stage, type of treatment, length of treatment, and complications. Tracheostomy wounds treated as an out-patient were excluded from the study. RESULTS: Eighteen subjects, which included both in-patients and out-patients, were treated with AG and/or MD during the study period for tracheostomy-related wounds. Of the 26 subjects with tracheostomies performed during the study period, 10 (38.5%) were treated for postoperative wounds. A total of 11 subjects completed their in-patient wound treatment and were thus included in the study. Average subject age was 5.3 y (range 0.25-15.6 y). Wound locations were as follows: infrastomal region (n ‫؍‬ 8), stoma (n ‫؍‬ 2), and lateral neck (n ‫؍‬ 1). Six subjects had stage 2 wounds, 4 had stage 3 wounds, and 1 had a stage 4 ulcer. All wounds achieved complete epithelialization following treatment with MD and/or AG. The average length of treatment was 12.8 d (range 6 -28 d). No adverse effects were identified. CONCLUSIONS: Postoperative tracheostomy wounds are common. The use of MD and AG provides an effective and safe treatment for tracheostomy-related ulcers.

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“…All of these factors must be assessed one by one by the pediatrician and surgeon in conjunction and the indication for tracheostomy must be based on the individual conditions of each child. 5,15 After the first successful pediatric tracheostomy was completed in 1766, the procedure began to be carried out specifically for children with airway obstruction, to the extent that it was indicated for the management of children with diphtheria, laryngitis and laryngeal edema. 9 Tracheostomy then came to be indicated in order to facilitate aspiration of secretions from the airways of children intubated for long periods.…”

Section: Indicationsmentioning

confidence: 99%

“…4,15,25,26 The number of complications is even higher during the neonatal period, particularly among preterms, and tracheostomy is considered a high-risk procedure in this age group. 3 This can in part be explained by the smaller tubes used with these children and also by the diseases involved, in particular bronchopulmonary dysplasia.…”

Section: Complicationsmentioning

confidence: 99%

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Traqueostomia na criança

Fraga¹,

Souza²,

Kruel³

2009

J. Pediatr. (Rio J.)

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Objective: To provide an up-to-date review of pediatric tracheostomy, primarily focusing on indications, surgical technique, complications and hospital and home care.Sources: MEDLINE and PubMed databases were searched using the following keywords: tracheostomy, tracheotomy, children, newborn. Summary of the findings:Indications for tracheostomy in children are changing. Today the most common indication is prolonged ventilation. The age at the time of the procedure has also changed, with a peak incidence of tracheostomy in patients less than 1 year old. Except under emergency conditions, pediatric tracheostomy should be performed in the operating room with the child intubated. A horizontal skin incision with vertical tracheal incision and no tracheal resection is recommended. Although post-tracheostomy complications are not uncommon, they usually do not need special treatment or surgical procedures. Tracheostomy mortality can occur in up to 40% of pediatric cases, however the tracheostomy-related mortality rate is only 0 to 6%. Conclusions:The decision to perform a tracheostomy remains complex, and depends on several factors. The procedure is safe and with a low number of complications if carried out at a tertiary hospital by a trained and experienced team.J Pediatr (Rio J). 2009;85(2):97-103: Tracheostomy, tracheotomy, prolonged intubation, children, newborn.

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Indications, complications, and surgical techniques for pediatric tracheostomies—An update

Cited by 249 publications

References 32 publications

Prior Cardiac Surgery Is Independently Associated With Decreased Survival Following Infant Tracheostomy

Prior Cardiac Surgery Is Independently Associated With Decreased Survival Following Infant Tracheostomy

Enhanced Tracheostomy Wound Healing Using Maltodextrin and Silver Alginate Compounds in Pediatrics: A Pilot Study

Traqueostomia na criança

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