Tracheostomy for Infants Requiring Prolonged Mechanical Ventilation: 10 Years' Experience (original) (raw)
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Tracheostomy For Infants Requiring Prolonged Mechanical Ventilation: 10 Year Review
A56. PEDIATRIC AND NEONATAL CRITICAL CARE, 2012
Neonatology orn_infant_sub http://pediatrics.aappublications.org/cgi/collection/fetus:newb Fetus/Newborn Infant the following collection(s): This article, along with others on similar topics, appears in Permissions & Licensing tml http://pediatrics.aappublications.org/site/misc/Permissions.xh tables) or in its entirety can be found online at: Information about reproducing this article in parts (figures, Reprints http://pediatrics.aappublications.org/site/misc/reprints.xhtml Information about ordering reprints can be found online: rights reserved. Print
Infant Tracheostomy: A 10-year experience in A Tertiary Centre
Malaysian Journal of Paediatrics and Child Health
We aim to report our experience of infant tracheostomies in a period of 10 years and discuss the indications, complications, outcome, and follow-up. This case series will contribute to the data of shifting trends in paediatric tracheostomy indications and outcomes. This study aims to review the indications, complications, and outcomes for paediatric tracheostomy at Hospital USM. A retrospective evaluation of the last ten years of experience at Hospital USM for all infants under the age of one who undergoes tracheostomy from January 2011 to January 2021 was undertaken. During the research period, twelve tracheostomies were performed. Complete data were available for all patients. There were 8 (67%) males and 4 (33%) females. The patient's age at the time of tracheostomy ranged from one day to nine months, with the mean age of tracheostomy insertion being 95 days. The most frequent indication was prolonged ventilation (50%), followed by upper airway obstruction caused by a craniof...
Archives de Pédiatrie, 2020
Pediatric tracheostomy has evolved significantly in the past few decades and the optimal timing to perform it in children with respiratory assistance is still debated. The objective of this study was to describe the indications, timing, complications, and outcomes of infants on respiratory support who had a tracheostomy in a tertiary pediatric intensive care unit (PICU). Methods: All children younger than 18 months of corrected age requiring respiratory support for at least 1 week and who had a tracheostomy between January 2005 and December 2015 were included. Their demographic and clinical data and their outcomes at 24 months of corrected age were collected and analyzed after approval from the CHU Sainte-Justine ethics committee. Results: During the study period, 18 children (14 preterm infants, 4 polymalformative syndromes, and 2 diaphragmatic hernias) were included. The median corrected age at tracheostomy was 97 days (0-289 days) and 94.4% were elective. The indications for tracheostomy were ventilation for more than 7 days with (61.1%) or without (38.9%) orolaryngotracheal anomaly. The median number of consultants involved per patient was 16 consultants (10-23 consultants). The median hospital length of stay was 122 days (8-365 days) before tracheostomy and 235 days (22-891 days) after tracheostomy. The median invasive ventilation time was 68 days (8-168 days) before tracheostomy and 64 days (5-982 days) after tracheostomy. In terms of complications, there were nine cases of tracheitis and five cases of tracheal granulomas. At 24 months of corrected age, 17 of 18 children survived, one of/17 was still hospitalized, three of 17 were decannulated, three of 17 received respiratory support via their tracheostomy, 11 of 17 were fed with a gastrostomy, and all had neurodevelopmental delay. Conclusion: Tracheostomy in infants requiring at least 1 week of ventilation is performed for complex cases and is favored for orolaryngotracheal anomalies. Clinicians should anticipate the need for developmental care in this population.
Optimal Time of Tracheotomy in Infants
Global Pediatric Health, 2015
Objective. Infants with respiratory failure may require prolonged intubation. There is no consensus on the time of tracheotomy in neonates. Methods. We evaluated infants applied tracheotomy, time of procedure, and early complications in our neonatal intensive care unit (NICU) retrospectively from January 2012 to December 2013. Results. We identified 9 infants applied tracheotomy with gestational ages 34 to 41 weeks. Their diagnoses were hypotonic infant, subglottic stenosis, laryngeal cleft, neck mass, and chronic lung disease. Age on tracheotomy ranged from 4 to 10 weeks. Early complication ratio was 33.3% with minimal bleeding (1), air leak (1), and canal revision requirement (1). We discharged 7 infants, and 2 infants died in the NICU. Conclusion. Tracheotomy makes infant nursing easy for staff and families even at home. If carried out by a trained team, the procedure is safe and has low complication. When to apply tracheotomy should be individualized, and airway damage due to pr...
Tracheostomy: Acute and long-term mortality and morbidity in very low birth weight premature infants
Journal of Pediatric Surgery, 1993
l Thirty-sixvery low birth weight premature infants (VLBW-PT) born at 24 to 32 weeks gestation and with birth weights 635 to 1,360 g who had tracheostomies performed for acquired subglottic stenosis or for prolonged mechanical ventilation were followed in relation to acute and long-term mortality and morbidity. Mortality due to the tracheostomy occurred in 4 patients (11%); mortality from all other causes was 25%. Death after hospital discharge was associated with the nonuse of prescribed cardiorespiratory monitors. Complications c 1 week postsurgery occurred in 31% of infants and complications 21 week postsurgery occurred in 64% of infants. Fifty percent of infants required tracheostomyfor ~-2 years and/or extensive reconstructive surgery of the airway. Parents should be counselled that VLBW-PT infants with a tracheostomy may require extended medical and home care. An effective home care program requires parental training in tracheostomy care, the use of ancillary equipment, and infant cardiopulmonary resuscitation.
Tracheostomy in Pediatric Intensive Care Unit—A Two Decades of Experience
Indian Journal of Critical Care Medicine, 2021
Aim and objective: To study the profile, indications, related complications, and predictors of decannulation and mortality in patients who underwent tracheostomy in the pediatric intensive care unit (PICU). Materials and methods: Retrospective analysis of prospectively collected data of tracheostomies was done on patients admitted at PICU. Demographics, primary diagnosis, indication of tracheostomy, and durations of endotracheal intubation, mechanical ventilation, and tracheostomy cannulation were recorded. The indication was recorded in one of the four categories-upper airway obstruction (UAO), central neurological impairment (CNI), prolonged mechanical ventilation, and peripheral neuromuscular disorders). Results: Two hundred ninety cases were analyzed. UAO (42%) and CNI (48.2%) were main indications in the halves of the study period, respectively. Decannulation was successful in 188 (64.8%) patients. Seventy-seven percentage UAO patients were decannulated successfully [OR (odds ratio); 95% CI (confidence interval), 2.647; 1.182-5.924, p = 0.018]. Age <1 year (0.378; 0.187-0.764; p = 0.007), nontraumatic, noninfectious central neurological diseases (0.398; 0.186-0.855; p = 0.018), and malignancy (0.078; 0.021-0.298; p <0.001), durations of posttracheostomy ventilation (0.937; 0.893-0.983; p = 0.008), and stay in the PICU (0.989; 0.979-0.999; p = 0.029) were predictors of unsuccessful decannulation. There were 91 (31.4%) deaths. Age <1 year (2.39 (1.13-5.05; p = 0.02), malignancy (17.55; 4.10-75.11; p <0.001), durations of posttracheostomy ventilation (1.06; 1.006-1.10; p = 0.028), and hospital stay (1.007; 1.0-1.013; p = 0.043) were independent predictors of mortality. Indication of UAO favored survivor (0.24; 0.09-0.57; p <0.001). Conclusion: The indications for tracheostomy in children had changed over the years. Infancy, primary diagnosis, length of posttracheostomy ventilation, and stay in the PICU and hospital were independent predictors of decannulation and mortality. What This Adds Similar to developed countries, the age at the time of tracheostomy and indication are changing. Inability to decannulate and mortality were associated with the age of a child at the time of tracheostomy, indication, medical diagnosis, and duration of postprocedure mechanical ventilation and stay in the hospital.
Tracheomegaly among Extremely Preterm Infants on Prolonged Mechanical Ventilation
The Journal of Pediatrics, 2019
By using phantom radiographs, the accuracy of tracheal measurements was established. Preterm infants (£29 weeks) were enrolled in short (<7 days) and prolonged ventilation (³28 days) groups. Both groups had 3 weight categories, namely, <1000 g, 1000-1999 g, and >2000 g. Tracheal sizes were measured on serial chest radiographs (CXR). We noted tracheomegaly in association with prolonged ventilation at ³1000 g.
Tracheostomy in Infants after Cardiac Surgery: Indications, Timing and Outcomes
Clinical Cardiology and Cardiovascular Interventions, 2021
Objective: There is little consensus on the indications and optimal timing of tracheostomy in the pediatric population. Our primary aim was to determine if early tracheostomy improves patient outcomes (between 10th and 15th postoperative day). Methods: A retrospective review of 84 neonates and infants requiring tracheostomy after cardiac surgery between January 1997 and December 2019 was performed. Indications and timings for tracheostomy, and risk factors for mortality were analyzed using Cox regression analysis. The receiver operating characteristic curve analysis, Youden’s index, sensitivity and specificity plot were performed to determine the optimal cut-off point of the timing of tracheostomy. Results: Twenty-five (29.76%) neonates and 59 (70.23%) infants with a median weight 7.6 kg (IQR: 3.1-9.25 kg) were studied. Extubation failure and unsuccessful weaning from ventilator occurred in 45 (53.6%) and 39 (46.4%) patients respectively. The timing of tracheostomy of 15 days as the...
Invasive and noninvasive neonatal mechanical ventilation
Respiratory care, 2003
Neonatal respiratory failure consists of several different disease entities, with different pathophysiologies. During the past 30 years technological advances have drastically altered both the diagnostic and therapeutic approaches to newborns requiring mechanical assistance. Treatments have become both patient- and disease-specific. The clinician has numerous choices among the noninvasive and invasive ventilatory treatments that are currently in use. This article reviews the pathophysiology of respiratory failure in the newborn and the available methods to treat it, including continuous positive airway pressure, conventional and high-frequency mechanical ventilation, extracorporeal membrane oxygenation, and styles of ventilation and monitoring.
Pediatric tracheostomy: a review
Tracheostomy is a life shaving surgery done in critically sick patients. Pediatric tracheostomy is a surgical procedure performed since ancient times. Performing tracheostomy in the pediatric age group is often challenging because of its association with morbidity and mortality. The indications for pediatric tracheostomy have been changed significantly in the last few decades. In pediatric patients, the common indications for tracheostomy are prolonged ventilation and upper airway obstruction. Advanced methods in pediatric anesthesia and increased awareness for vaccination for serious infections like measles, mumps, diphtheria, tetanus, and hemophilus influenza type b (Hib) among pediatric age increased the changing indications for performing tracheostomy from emergency to more elective one. There are numerous research papers available in medical literature for adult tracheostomy with its indications, surgical techniques, and complications, but literature for pediatric tracheostomy is scarce. This is always a requirement for standard guidelines for standard protocols for pediatric tracheostomy. Proper standardization of pediatric tracheostomy, timing, and appropriate indications are helpful to reduce the complications and mortality related to pediatric tracheostomy. Here, this review article is attempting to discuss the indications, preoperative evaluation, surgical techniques, complications, and post-operative care of the pediatric tracheostomy.