Indications, complications, and surgical techniques for pediatric tracheostomies -: An update

被引:171
作者
Kremer, B
Botos-Kremer, AI
Eckel, HE
Schlöndorff, G
机构
[1] Univ Maastricht, Dept Otorhinolaryngol Head & Neck Surg, Maastricht, Netherlands
[2] Municipal Hosp Duren, Dept Pediat, Duren, Germany
[3] Univ Cologne, Dept Otorhinolaryngol, Cologne, Germany
[4] Univ Aachen, Dept Otorhinolaryngol Head & Neck Surg, D-5100 Aachen, Germany
关键词
tracheostomy; indication; complication; outcome;
D O I
10.1053/jpsu.2002.36184
中图分类号
R72 [儿科学];
学科分类号
100202 ;
摘要
Background. With the decrease of life-threatening obstructive upper airway infections and the ongoing improvement of intensive care medicine, the role of tracheostomy in children has been changing considerably, until now. The aim of this study was to establish data regarding indications, complications, and techniques of pediatric tracheostomy, which would reflect the current state of science. Methods:The authors analyzed the international literature as well as their own experience with 25 children less than 6 years of age who were operated on between 1980 and 1996. Results: Literature proved to be very heterogeneous in terms of terminology, patient groups, operation techniques, indications, and complications. Within the past decades, long-term intubation and congenital anomalies of the upper respiratory tract have become increasingly prevalent, whereas inflammatory diseases were less and less an indication for tracheostomy. Endotracheal intubation as an alternative has resulted in less frequent tracheostomies in general. Today, children can be ventilated for months without considerable complications. However, individual, clinical, and fiberoptical controls are necessary. Tracheostomy-related complications have not changed significantly. Fatalities are mostly caused by the underlying disease. The most frequent causes of tracheostomy-related death are cannula obstruction and accidental decannulation. The most frequent early complications are pneumomediastinum, pneumothorax, wound complications, and bleedings. Subsequent complications most often are granulations and tracheal stenosis. Conclusions: The authors' research agreed widely with that in the literature. However, no tracheostomy-related death occurred. Possibly, this was because of their operative technique. In the opinion of the authors, establishing a cartilage window facilitates cannula exchange and reduces the risk of a fatal accidental decannulation. Copyright 2002 Elsevier Science (USA). All rights reserved.
引用
收藏
页码:1556 / 1562
页数:7
相关论文
共 40 条
[1]  
ARCAND P, 1988, J OTOLARYNGOL, V17, P121
[2]   INFANT TRACHEOTOMY - ENDOSCOPY AND DECANNULATION [J].
BENJAMIN, B ;
CURLEY, JWA .
INTERNATIONAL JOURNAL OF PEDIATRIC OTORHINOLARYNGOLOGY, 1990, 20 (02) :113-121
[3]  
BIESALSKI P, 1964, HALS NASEN OHRENHEIL, P629
[4]   10-YEAR REVIEW OF PEDIATRIC TRACHEOTOMY [J].
CARTER, P ;
BENJAMIN, B .
ANNALS OF OTOLOGY RHINOLOGY AND LARYNGOLOGY, 1983, 92 (04) :398-400
[5]   TRACHEOTOMIES - A 10-YEAR EXPERIENCE IN 319 CHILDREN [J].
CRYSDALE, WS ;
FELDMAN, RI ;
NAITO, K .
ANNALS OF OTOLOGY RHINOLOGY AND LARYNGOLOGY, 1988, 97 (05) :439-443
[6]  
DEMPSTER J H, 1986, Journal of the Royal College of Surgeons of Edinburgh, V31, P359
[7]   A twenty year (1971-1990) review of tracheostomies in a major paediatric hospital [J].
Donnelly, MJ ;
Lacey, PD ;
Maguire, AJ .
INTERNATIONAL JOURNAL OF PEDIATRIC OTORHINOLARYNGOLOGY, 1996, 35 (01) :1-9
[8]  
LANGER H, 1949, Z Stomatol (1921), V46, P70
[9]  
DUTTON JM, 1995, HEAD NECK-J SCI SPEC, V9, P403
[10]   DEVELOPMENTAL INFLUENCES OF INFANT TRACHEOSTOMY [J].
FREELAND, AP ;
WRIGHT, JLW ;
ARDRAN, GM .
JOURNAL OF LARYNGOLOGY AND OTOLOGY, 1974, 88 (10) :927-936