Outcomes and complications of simple layered closure of persistent tracheocutaneous fistula after tracheostomy in childhood

Wong, Tiffany; Macpherson, Orla; Docherty, Sophie; Gray, J.H.; Clement, W A; Kubba, Haytham

doi:10.1016/j.ijporl.2022.111427

Cited by 5 publications

(2 citation statements)

References 33 publications

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“…There was a signi cant complication after primary multilayer suturing in the present study. Bag-mask ventilation and laryngoscopy might be di cult or impossible, and emergency tracheostomy might be necessary after primary multilayer suturing [15]. Although there was also a patient with an urgent respiratory condition after temporary suture, he did not need orotracheal intubation and his airway condition immediately improved after removal of the stitches.…”

Section: Discussionmentioning

confidence: 99%

Safety evaluation of a stepwise tracheostomy decannulation program in pediatric patients

Obayashi,

Fukumoto,

Yamoto

et al. 2023

Pediatr Surg Int

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In the event of failed tracheostomy decannulation, patients might have a tragic course of events. We retrospectively evaluated our stepwise tracheostomy decannulation program and examined its safety. MethodsA 12-year retrospective study of pediatric patients was conducted. The decannulation program was performed on patients who had airway patency by laryngobronchoscopy and whose cannula could be capped during the day. A stepwise decannulation program was performed: continuous 48-hour capping trial during hospitalization (Phase 1), removal of the tracheostomy tube for 48 hours during hospitalization (Phase 2), and outpatient observation (Phase 3). If a persistent tracheocutaneous stula existed, the stula was closed by surgery (Phase 4). ResultsThe 77 patients in the study underwent 86 trials. The age at the rst time of the decannulation program was 6.5 ± 3.6 years old. Sixteen trials failed (18.6%): 8 trials in Phase 1, 2 trials in Phase 2, 4 trials in Phase 3, and 2 trials in Phase 4. Most decannulation failures were due to desaturation in Phase 1/2 and dyspnea in Phase 3/4. The time to reintubation after decannulation was 15-383 days in Phase 3/4. ConclusionsPatients could fail at every phase of the program, suggesting that a stepwise decannulation program contributes to safety.

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Section: Discussionmentioning

confidence: 99%

Safety evaluation of a stepwise tracheostomy decannulation program in pediatric patients

Obayashi,

Fukumoto,

Yamoto

et al. 2023

Pediatr Surg Int

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“…The primary postoperative concern is air escape causing subcutaneous emphysema, pneumothorax, and/or pneumomediastinum. Major airway/respiratory complications in the primary closure technique have recently been reported in a range from 3–7%, with overall complication rate between 20% and 24% [35 ▪ ,36–39]. Notably, severe respiratory complications are also reported in the secondary intention technique, though at a lower frequency of 2% [35 ▪ ].…”

Section: Tracheocutaneous Fistulamentioning

confidence: 99%

Pediatric tracheostomy decannulation: what's the evidence?

Raynor,

Bedwell

2023

Current Opinion in Otolaryngology &Amp; Head &Amp; Neck Surgery

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Purpose of review Pediatric decannulation failure can be associated with large morbidity and mortality, yet there are no published evidence-based guidelines for pediatric tracheostomy decannulation. Tracheostomy is frequently performed in medically complex children in whom it can be difficult to predict when and how to safely decannulate. Recent findings Published studies regarding pediatric decannulation are limited to reviews and case series from single institutions, with varying populations, indications for tracheostomy, and institutional resources. This article will provide a review of published decannulation protocols over the past 10 years. Endoscopic airway evaluation is required to assess the patency of the airway and address any airway obstruction prior to decannulation. There is considerable variability in tracheostomy tube modification between published protocols, though the majority support a capping trial and downsizing of the tracheostomy tube to facilitate capping. Most protocols include overnight capping in a monitored setting prior to decannulation with observation ranging from 24 to 48 h after decannulation. There is debate regarding which patients should have capped polysomnography (PSG) prior to decannulation, as this exam is resource-intensive and may not be widely available. Persistent tracheocutaneous fistulae are common following decannulation. Excision of the fistula tract with healing by secondary intention has a lower reported operative time, overall complication rate, and postoperative length of stay. Summary Pediatric decannulation should occur in a stepwise process. The ideal decannulation protocol should be safe and expedient, without utilizing excessive healthcare resources. There may be variability in protocols based on patient population or institutional resources, but an explicitly described protocol within each institution is critical to consistent care and quality improvement over time. Further research is needed to identify selection criteria for who would most benefit from PSG prior to decannulation to guide allocation of this limited resource.

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Amoxicillin/clavulanic-acid

2023

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Outcomes and complications of simple layered closure of persistent tracheocutaneous fistula after tracheostomy in childhood

Cited by 5 publications

References 33 publications

Safety evaluation of a stepwise tracheostomy decannulation program in pediatric patients

Safety evaluation of a stepwise tracheostomy decannulation program in pediatric patients

Pediatric tracheostomy decannulation: what's the evidence?

Amoxicillin/clavulanic-acid

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