Pediatric tracheostomy

Abstract

ResumoObjetivo: Apresentar revisão atualizada sobre a traqueostomia na idade pediátrica, com ênfase nas indicações, técnica cirúrgica, complicações e manejo da traqueostomia a nível hospitalar e domiciliar. Fontes dos dados:Foram selecionados pelo site de busca médica (MEDLINE e PubMed) artigos originais e de revisão sobre traqueostomia na criança, utilizando as seguintes palavras-chave: tracheostomy, tracheotomy, children, newborn. Síntese dos dados:A indicação de traqueostomia vem mudando progressivamente. No momento, ela é mais indicada na criança em ventilação mecânica prolongada. A faixa etária mais comum do procedimento também mudou, sendo atualmente mais comumente realizada em crianças menores de 1 ano de idade. Exceto em situações de emergência, a traqueostomia deve ser realizada em unidade cirúrgica, com a criança entubada. É preconizada a incisão transversa da pele e abertura longitudinal da traqueia, sem ressecção da mesma. Embora as complicações da traqueostomia na criança não sejam incomuns, elas, na maioria das vezes, não necessitam de tratamentos sofisticados ou mesmo de intervenção cirúrgica. Embora a mortalidade possa ocorrer em até 40% das crianças traqueostomizadas, ela é diretamente relacionada à traqueostomia em apenas 0 a 6% das crianças. Conclusões:A decisão de realizar traqueostomia na criança continua complexa e dependente de vários fatores. O procedimento é seguro e com menores complicações quando realizado em hospital terciário de referência e por equipe treinada e experiente. J Pediatr (Rio J). 2009;85(2):97-103:Traqueostomia, entubação prolongada, criança, recém-nascido. AbstractObjective: 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.

Tracheostomy in pediatric burn patients

“…Past controversies about tracheostomies in burn patients have been resolved by current reports that indicate due to lower airway ventilation volumes and lower tracheostomy cuff pressures, tracheostomies are generally safe and effective [2,6,9,10]. However, although tracheostomies provide safe airways for pediatric burn patients, decisions on removal of tracheostomies may be influenced by age related factors and established guidelines for tracheostomy care to reduce time to decannulation have not been well studied especially in children [11,12].…”

Paediatric patients with a tracheostomy: a multicentre epidemiological study

“…Others have reported figures for children ,1 yr of age of between 50% and 66% [3,8,19], which is more like the 60.2% in our series. There has also been a growing trend for the procedure to be used in premature infants (10.8%) [15,20] and in children with multiple chronic disorders or severe congenital diseases in neonatal or paediatric ICUs [9,21,22]. The mean age for tracheostomy in most series ranges from 3.2 to 7.8 months [3,6,8,17], or around 3 yrs of age [2,16].…”

Anatomy and morphometric aspects of the trachea of Saimiri sciureus Linnaeus, 1758: knowledge for emergency procedures

“…In situations where it is not possible in orotracheal intubation or placement of the laryngeal mask, the alternative to keep the ventilation is the placement of the tracheostomy tube (Fraga et al 2009). This species should be used neonatal Shiley tracheostomy tube number 3.0 (Mallinckrodt ® ).…”