Tracheostomy Complications in Institutionalized Children with Long-term Tracheostomy and Ventilator Dependence
Tracheostomy Complications in Institutionalized Children with Long-term Tracheostomy and Ventilator Dependence
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DOI：
10.1177/0194599816628486
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发表时间：
2016-04-01
影响因子：
3.4
通讯作者：
Baldassari, Cristina M.
中科院分区：
文献类型：
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作者：
Wilcox, Lyndy J.;Weber, Brittany C.;Baldassari, Cristina M.
目标 (1) 确定接受慢性气管切开术的住院儿童的气管切开术并发症。 (2) 确定慢性气管切开住院儿童发生气管切开并发症的易感因素。研究设计案例系列，并回顾10年以上的图表。设置三级儿童医院。受试者和方法21岁之前接受气管切开术并居住在儿科护理机构的儿童被纳入研究。大多数儿童依赖呼吸机，并患有严重的合并症，包括发育迟缓和脑瘫。记录气管造口并发症和计划外住院的数量。还回顾了气管造口并发症的干预措施。结果 纳入了 32 名因慢性气管造口而住院的儿童。气管切开时的平均年龄为 5.4 岁，平均住院时间为 9.1 年。 27 名儿童 (84%) 出现气管切开术并发症。并发症总数为 79 例。最常见的气管造口并发症是造口周围肉芽形成 (n = 13) 和造口上肉芽形成 (n = 12)。气管切开时的年龄、住院时间和呼吸机依赖并不能预测发生并发症的可能性。在 32 名患者中，有 20 名在研究期间在急诊室接受了评估，研究期间有 48 名患者因气管造口相关并发症而计划外入院。对总共 20 名患有气管造口并发症的儿童进行了 45 次紧急直接喉镜和支气管镜检查。结论 气管造口并发症在长期接受气管造口的住院儿童中很常见，且处理起来具有挑战性。需要进一步的研究来确定减少该人群气管造口并发症的新方法。
Objectives (1) To identify tracheostomy complications in institutionalized children with chronic tracheostomy. (2) To determine factors that predispose to development of tracheostomy complications in institutionalized children with chronic tracheostomy.Study Design Case series with chart review over 10 years.Setting Tertiary children's hospital.Subjects and Methods Children were included if they underwent tracheostomy before 21 years of age and resided at a pediatric nursing facility. Most children were ventilator dependent and had severe comorbid medical conditions, including developmental delay and cerebral palsy. The number of tracheostomy complications and unplanned hospital admissions were recorded. Interventions for tracheostomy complications were also reviewed.Results Thirty-two institutionalized children with chronic tracheostomy were included. The mean age at time of tracheostomy was 5.4 years, with a mean duration of institutionalization of 9.1 years. Twenty-seven children (84%) experienced tracheostomy complications. The total number of complications was 79. The most common tracheostomy complications identified were peristomal granulation (n = 13) and suprastomal granulation (n = 12). Age at time of tracheostomy, duration of institutionalization, and ventilator dependence did not predict the likelihood of developing a complication. Of 32 patients, 20 were evaluated in the emergency room during the study, and there were 48 unplanned admissions for tracheostomy-related complications during the study. Forty-five urgent direct laryngoscopy and bronchoscopy procedures were performed in a total of 20 children with tracheostomy complications.Conclusions Tracheostomy complications are common in institutionalized children with chronic tracheostomy and are challenging to manage. Further research is necessary to determine novel ways to reduce tracheostomy complications in this population.