Pediatric tracheostomy revisited: A nine‐year experience using horizontal intercartilaginous incision

Song, Jae-Jin; Choi, Ik Joon; Chang, Hyun Ha; Kim, Do Hun; Chang, Hyoung Woo; Park, Gyeong Hun; Kim, Min Su; Sung, Myung‐Whun; Hah, J. Hun

doi:10.1002/lary.24882

Cited by 33 publications

(19 citation statements)

References 29 publications

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“…Tracheostomy complications occur surprisingly frequently and influence outcomes . One recent North American paediatric tertiary centre study reported early complications in 11% and late complications in 68.8% of all tracheostomies inserted , which is consistent with other reported institutional case series . The early postoperative complication rate in preterm infants may be double that of full‐term infants , and the requirement for tracheostomy in the preterm period is also associated with poor developmental outcomes .…”

Section: Introductionsupporting

confidence: 79%

Multidisciplinary guidelines for the management of paediatric tracheostomy emergencies

et al. 2018

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Summary Temporary and permanent tracheostomies are required in children to manage actual or anticipated long‐term ventilatory support, to aid secretion management or to manage fixed upper airway obstruction. Tracheostomies may be required from the first few moments of life, with the majority performed in children < 4 years of age. Although similarities with adult tracheostomies are apparent, there are key differences when managing the routine and emergency care of children with tracheostomies. The National Tracheostomy Safety Project identified the need for structured guidelines to aid multidisciplinary clinical decision making during paediatric tracheostomy emergencies. These guidelines describe the development of a bespoke emergency management algorithm and supporting resources. Our aim is to reduce the frequency, nature and severity of paediatric tracheostomy emergencies through preparation and education of staff, parents, carers and patients.

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Section: Introductionsupporting

confidence: 79%

Multidisciplinary guidelines for the management of paediatric tracheostomy emergencies

et al. 2018

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“…The effect of the type of tracheal incision on the subsequent stenosis and tracheomalacia rate in children has been a subject of considerable discussion, with various operative techniques being advocated to minimize the risk and complications. 58,[61][62][63] There are 3 main concerns that should be reviewed when a tracheostomy incision site is being considered: prevention of accidental decannulation (this is the primary cause of tracheostomyrelated fatality in children); prevention of long-term tracheal stenosis 58,64 ; and awareness of the underlying indication for tracheostomy. For example, if the child has subglottic stenosis that will be repaired as a single-stage procedure in the future, it may be beneficial to place the tracheostomy high in the neck.…”

Section: Surgical Tracheostomymentioning

confidence: 99%

“…47 There is an ongoing debate as to whether a vertical or horizontal tracheal incision, with or without flap, should be made. [62][63][64][65] The basic principle consists of incising as few tracheal rings as possible. Irrespective of the incision used, the tube is likely to inflict some damage on the tracheal cartilage.…”

Section: Surgical Tracheostomymentioning

confidence: 99%

Tracheostomy in Infants and Children

2017

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Over the last decade, tracheostomy has been increasingly performed in children, aligned with the improvements in neonatal and pediatric ICU care. Nowadays, the majority of children with tracheostomy represent a very complex cohort of patients with sustained reliance on tracheostomy and related medical technology for long-term survival. Tracheostomy is one of the most commonly performed procedures in the adult ICU. Contrary to adult practice, tracheostomy is a much less common procedure in the pediatric ICU, being performed in < 3% of patients. There is no definite consensus about the length of time a child should remain endotracheally intubated before the placement of a tracheostomy. Tracheostomy in children also continues to remain a predominantly surgical procedure, with percutaneous tracheostomy being performed infrequently and only considered feasible in older children. The indications, preoperative considerations, and procedure types for tracheostomy in children are reviewed. There is also a lack of consensus on an optimal pediatric decannulation protocol. The literature discusses a myriad of protocols that use varying combinations of in-patient/out-patient resources, specialized tests, and procedures An ideal decannulation protocol is presented, as well as review of recently published decannulation algorithms. Finally, children with tracheostomy have a higher risk of adverse events and mortality, which are largely secondary to their comorbidities rather than the tracheostomy. The majority of the tracheostomy-related events are in fact potentially preventable. There is a recognized need for improvement and coordination of care of pediatric patients with tracheostomy. A multidisciplinary coordinated approach to tracheostomy care has already shown promising results. This paper seeks to review the pertinent literature regarding quality improvement initiatives for tracheostomy care, including review of the recently established Global Tracheostomy Collaborative.

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“…20,22 Bununla birlikte Song ve ark., horizontal trakeal insizyon ile açtıkları 111 pediatrik trakeotomi hastasında, komplikasyon ve mortalite oranlarının literatürle uyumlu olduğunu belirtmişlerdir. 23 Trakeotomi sonrası erken dönemde karşılaşılan ve mortaliteye sebep olabilen önemli bir sorun da kazara dekanülasyondur. 24,25 Tüpün tekrar yerleştirilmesi sırasında trakea ön yüzünden anterior mediastene uzanan bir false pasaj oluşması riski ve buna bağlı hastanın havalandırılamaması erken dekanülasyonu tehlikeli bir durum kılmaktadır.…”

Section: Preoperati̇f Değerlendi̇rme Ve Cerrahi̇ Tekni̇kunclassified