Pediatric tracheostomy: a 13-year experience

Alladi, Anand; Rao, Subba; Das, Kanishka; Charles, A. R.; D'Cruz, Ashley

doi:10.1007/s00383-004-1277-5

Cited by 61 publications

(54 citation statements)

References 14 publications

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“…Over recent years, numerous studies in different countries have reported the individual experience of various hospitals, with the number of patients varying from 36 to 362 over periods of time ranging from 2 to 37 yrs [3,5,6,8,9,[16][17][18]. Review of these reports reveals differences between the various centres.…”

Section: Discussionmentioning

confidence: 99%

Paediatric patients with a tracheostomy: a multicentre epidemiological study

Pérez-Ruíz¹,

Caro²,

Pérez‐Frías³

et al. 2012

Eur Respir J

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Changes in the indications for tracheostomy in children have led to the progressively greater involvement of the paediatric pulmonologist in the care of these patients. The aim of this study was to review the current profile of tracheostomised children in Spain.We undertook a longitudinal, multicentre study over 2 yrs (2008 and 2009) of all patients aged between 1 day and 18 yrs who had a tracheostomy.The study, involving 18 Spanish hospitals, included 249 patients, of whom 150 (60.2%) were ,1 yr of age. The main indications for the procedure were prolonged ventilation (n5156, 62.6%), acquired subglottic stenosis (n534, 13.6%), congenital or acquired craniofacial anomalies (n525, 10%) and congenital airway anomalies (n524, 9.6%). The most frequent underlying disorders were neurological diseases (n5126, 50.6%) and respiratory diseases (n598, 39.3%). Over the 2-yr study period, 92 (36.9%) children required ventilatory support, and decannulation was achieved in 59 (23.7%). Complications arose in 117 patients (46.9%). Mortality attributed to the underlying condition was 12.5% and that related directly to the tracheostomy was 3.2%.Respiratory complexity of tracheostomised children necessitates prolonged, multidisciplinary follow-up, which can often extend to adulthood.

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Section: Discussionmentioning

confidence: 99%

Paediatric patients with a tracheostomy: a multicentre epidemiological study

Pérez-Ruíz¹,

Caro²,

Pérez‐Frías³

et al. 2012

Eur Respir J

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“…[1][2][3] These reviews have reported a mortality rate of 34 -47%, significantly higher than the mortality rates reported in non-cardiac surgical populations. [4][5][6] Two large multi-institutional studies performed by Berry and colleagues 7,8 demonstrated increased risk of in-hospital mortality following tracheostomy in children with congenital heart disease, the majority of whom had undergone cardiac surgical repair or palliation. To our knowledge, no study to date has determined whether tracheostomy following pediatric cardiac surgery continues to be associated with poorer outcomes following hospital discharge relative to patients who require tracheostomy in association with other disease processes.…”

Section: Introductionmentioning

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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“…[11][12][13][14] The increase in tracheostomies within this age group has been attributed to increases in the survival of premature newborn infants and those requiring prolonged ventilation. 4 The decision to perform a tracheostomy on a child is complex and depends on several factors, including the severity of airway obstruction, the difficulty and duration of intubation and the child's subjacent medical condition. 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.…”

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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Pediatric tracheostomy: a 13-year experience

Cited by 61 publications

References 14 publications

Paediatric patients with a tracheostomy: a multicentre epidemiological study

Paediatric patients with a tracheostomy: a multicentre epidemiological study

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

Traqueostomia na criança

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