Pediatric tracheostomies: A recent experience from one academic center
Pediatric tracheostomies: A recent experience from one academic center
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DOI：
10.1097/01.pcc.0000298641.84257.53
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发表时间：
2008-01-01
影响因子：
4.1
通讯作者：
McPherson, Mona L.
中科院分区：
文献类型：
--
作者：
Graf, Jeanine M.;Montagnino, Barbara A.;McPherson, Mona L.
目标。目的：描述小儿气管切开术的适应证、手术时机、住院时间、住院费用和出院处理。设计：回顾性病例系列。设置。城市大型学术儿科医院。患者：70名儿童和青少年在24个月期间接受气管切开术。干预：无。测量和主要结果：使用医院数据库记录来确定人口统计学和再住院率，列出费用，并确认死亡。气管切开术的适应症包括呼吸道阻塞、呼吸道保护不足、慢性肺部疾病、神经肌肉无力和中枢性换气不足。气管切开术的手术时机分为三类：长时间机械通气、择期或急诊。总体住院天数中位数为46天(14-254天)，住院费用中位数为136,718美元(36,237美元-913,934美元)。延长机械通气组在使用呼吸机的中位时间为26天(平均37.5天)后行气管切开。81%的儿童已出院回家；63%的儿童在6个月内重新入院，11%的儿童需要四次或更多入院。6个月死亡率为13%，无一例死亡与气管切开有关。结论：气管切开患儿是一个异质性人群。需要气管切开以进行长期机械通气的儿童比选择性或紧急接受气管切开术的儿童住院时间更长。在这一复杂的患者群体中，应该预料到再次住院。
Objectives. To describe the indications, surgical timing, length of stay, hospital charges, and discharge disposition of pediatric tracheostomy patients.Design: Retrospective case series. Setting. Large urban academic pediatric hospital.Patients: Seventy children and adolescents undergoing tracheostomy placement over a 24-month period.Interventions: None.Measurements and Main results: Hospital database records were used to determine demographics and readmission rates, tabulate charges, and confirm deaths. Indications for tracheostomies included airway obstruction, inadequate airway protection, chronic lung disease, neuromuscular weakness, and central hypoventilation. Surgical timing of the tracheostomy was grouped into three categories: prolonged mechanical ventilation, elective, or emergent. The overall median hospital stay was 46 days (range 14-254) with a median hospital charge of $136,718 (range $36,237-$913,934). The prolonged mechanical ventilation group underwent a tracheostomy after a median of 26 days (mean 37.5 days) on the ventilator. Eighty-one percent of children were discharged home; 63% of children were readmitted within 6 months, with 11% requiring four or more admissions. The six-month mortality rate was 13%; no deaths were related to the tracheostomy.Conclusions: Children with tracheostomies are a heterogeneous population. Children who require tracheostomy for longterm mechanical ventilation have longer hospital stays than children who receive a tracheotomy on an elective or emergent basis. Hospital readmissions should be anticipated in this complex group of patients.