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Namavarian A, Levy BB, Tepsich M, McKinnon NK, Siu JM, Propst EJ, Wolter NE. Percutaneous tracheostomy in the pediatric population: A systematic review. Int J Pediatr Otorhinolaryngol 2024; 177:111856. [PMID: 38185003 DOI: 10.1016/j.ijporl.2024.111856] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/21/2023] [Revised: 12/25/2023] [Accepted: 01/02/2024] [Indexed: 01/09/2024]
Abstract
OBJECTIVE Percutaneous tracheostomy is routinely performed in adult patients but is seldomly used in the pediatric population due to concerns regarding safety and limited available evidence. This study aims to consolidate the current literature on percutaneous tracheostomy in the pediatric population. METHODS A systematic review following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines was conducted. MEDLINE, EMBASE, CINAHL, and Web of Science were searched for studies on pediatric percutaneous tracheostomy (age ≤18). The Joanna Briggs Institute and ROBINS-I tools were used for quality appraisal. RESULTS Twenty-one articles were included resulting in 143 patients. Patient age ranged from 2 days to 17 years, with the largest subpopulation of patients (n = 57, 40 %) being adolescents (age between 12 and 17 years old). Main indications for percutaneous tracheostomy included prolonged ventilation (n = 6), respiratory insufficiency (n = 5), and upper airway obstruction (n = 5). One-third (n = 47) of percutaneous tracheostomies were completed at the bedside in an intensive care unit. Select studies reported on surgical time and time from intubation to tracheostomy with a mean of 13.8 (SD = 7.8) minutes (n = 27) and 8.9 (SD = 2.8) days (n = 35), respectively. Major postoperative complications included tracheoesophageal fistula (n = 4, 2.8 %) and pneumothorax (n = 3, 2.1 %). There were four conversions to open tracheostomy. CONCLUSION Percutaneous tracheostomy had a similar risk of complications to open surgical tracheostomy in children and adolescents and can be performed at the bedside in a select group of patients if necessary. However, we feel that consideration must be given to the varying anatomical considerations in children and adolescents compared with adults, and therefore suggest that this procedure be reserved for adolescent patients with a thin body habitus and clearly demarcated and palpable anatomical landmarks who require a tracheostomy. When performed, we strongly support using endoscopic guidance and a surgeon who has the ability to convert to an open tracheostomy if required.
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Affiliation(s)
- Amirpouyan Namavarian
- Department of Otolaryngology-Head and Neck Surgery, University of Toronto, Toronto, ON, Canada
| | - Ben B Levy
- Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada; Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
| | | | - Nicole K McKinnon
- Hospital for Sick Children, Toronto, ON, Canada; Department of Paediatrics, University of Toronto, Toronto, ON, Canada; Interdepartmental Division of Critical Care Medicine, University of Toronto, ON, Canada
| | - Jennifer M Siu
- Department of Otolaryngology-Head and Neck Surgery, University of Toronto, Toronto, ON, Canada; Hospital for Sick Children, Toronto, ON, Canada
| | - Evan J Propst
- Department of Otolaryngology-Head and Neck Surgery, University of Toronto, Toronto, ON, Canada; Hospital for Sick Children, Toronto, ON, Canada
| | - Nikolaus E Wolter
- Department of Otolaryngology-Head and Neck Surgery, University of Toronto, Toronto, ON, Canada; Hospital for Sick Children, Toronto, ON, Canada.
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Carratola M, Hart CK. Pediatric tracheal trauma. Semin Pediatr Surg 2021; 30:151057. [PMID: 34172217 DOI: 10.1016/j.sempedsurg.2021.151057] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Tracheal trauma is an uncommon but potentially serious cause of airway injury in children. Presentation may be acute in cases of blunt or penetrating trauma, or delayed in cases of chronic irritation or indwelling endotracheal tubes. Symptoms include dyspnea, progressive respiratory distress, neck and chest swelling and ecchymosis, and dysphonia. Workup is pursued as allowed by the patient's clinical status and may include plain radiography, computed tomography, and endoscopy. Accuracy and efficiency of diagnosis is paramount for those at risk of rapid decompensation. Treatment may include observation, elective and strategic intubation, or primary surgical repair.
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Affiliation(s)
- Maria Carratola
- Division of Pediatric Otolaryngology-Head and Neck Surgery, Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, 3333 Burnet Avenue, MLC 2018, Cincinnati, OH 45229, USA
| | - Catherine K Hart
- Division of Pediatric Otolaryngology-Head and Neck Surgery, Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, 3333 Burnet Avenue, MLC 2018, Cincinnati, OH 45229, USA.
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Akcan FA, Dündar Y, Uluat A, Cebeci D, Sungur MA, Salman N, Ünlü İ. Pediatric Tracheotomies: A 5-Year Experience In 152 Children. ENT UPDATES 2018. [DOI: 10.32448/entupdates.458961] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
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Gollu G, Ates U, Can OS, Kendirli T, Yagmurlu A, Cakmak M, Aktug T, Dindar H, Bingol-Kologlu M. Percutaneous tracheostomy by Griggs technique under rigid bronchoscopic guidance is safe and feasible in children. J Pediatr Surg 2016; 51:1635-9. [PMID: 27297040 DOI: 10.1016/j.jpedsurg.2016.05.013] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2016] [Revised: 03/31/2016] [Accepted: 05/14/2016] [Indexed: 10/21/2022]
Abstract
OBJECTIVE The aim of this study is to report prospective data of pediatric cases that underwent percutaneous tracheostomy (PT) to show that PT is a safe and feasible procedure in children even in small infants. PATIENTS AND METHODS PT was done in 51 consecutive patients. Demographic data, indications, complications and outcome were recorded prospectively. Initial 6 PT was done by Giaglia technique whereas the Griggs technique was used in the consecutive 45 patients. RESULTS Fifty-one patients with mean age of 38±54months (1month-17years) and, mean weight of 12.4±13kg underwent PT. The only major complication was perforation of esophagus (n=1, 2%) which was recognized early and immediately repaired by cervical approach. This complication occurred in the 6th case done with the Giaglia technique. After conversion to the Griggs technique no major complication was encountered in the consecutive 45 procedures. The mean period of follow up was 21±13.7months. Narrowing of the stoma site requiring simple dilation was developed in 3 (5.8%) patients. CONCLUSION PT is a safe and easy procedure and a less invasive alternative to surgical tracheostomy even in small infants. We strongly recommend PT done by Griggs technique in children. It is important that it should be done in an operating room setting and under rigid bronchoscopic guidance.
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Affiliation(s)
- Gulnur Gollu
- Department of Pediatric Surgery, Ankara University Medical Faculty, Ankara, Turkey.
| | - Ufuk Ates
- Department of Pediatric Surgery, Ankara University Medical Faculty, Ankara, Turkey
| | - Ozlem S Can
- Department of Pediatric Anesthesiology, Ankara University Medical Faculty, Ankara, Turkey
| | - Tanil Kendirli
- Department of Pediatric Intensive Care, Ankara University Medical Faculty, Ankara, Turkey
| | - Aydin Yagmurlu
- Department of Pediatric Surgery, Ankara University Medical Faculty, Ankara, Turkey
| | - Murat Cakmak
- Department of Pediatric Surgery, Ankara University Medical Faculty, Ankara, Turkey
| | - Tanju Aktug
- Department of Pediatric Surgery, Ankara University Medical Faculty, Ankara, Turkey
| | - Hüseyin Dindar
- Department of Pediatric Surgery, Ankara University Medical Faculty, Ankara, Turkey
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Ang AHC, Chua DYK, Pang KP, Tan HKK. Pediatric Tracheotomies in an Asian Population: The Singapore Experience. Otolaryngol Head Neck Surg 2016; 133:246-50. [PMID: 16087023 DOI: 10.1016/j.otohns.2005.03.085] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2004] [Accepted: 03/15/2005] [Indexed: 11/26/2022]
Abstract
Objective: Over the past 2 decades, tracheotomy in children and infants has evolved from a primarily emergent procedure for upper airway obstruction into a semielective procedure for airway access in assisted ventilation. We present a 12-year retrospective review of tracheotomies performed in the pediatric population in Singapore. Study Design and Setting: We reviewed all tracheotomies performed in children below the age of 16 years in 2 tertiary pediatric medical centers in Singapore from January 1991 to December 2003. Indications for surgery are reviewed, and outcomes in terms of morbidity rate, mortality rate, postoperative rehabilitation, and duration of decannulation process were analyzed. Results: Tracheotomies were performed in 48 children during the study period. The mean age of patients was 3.24 years, with ages ranging from 16 days to 14 years. Sixty-three percent of tracheotomies were done within the 1st year of life. The chief indication was airway access for assisted ventilation. The overall complication rate was 31%. There were 13 attempts at decannulation, with 9 successes. No tracheotomy-related deaths occurred. Conclusion: Tracheotomy is a relatively safe procedure in children and infants. Lower decannulation rates and the evolving role of tracheotomy for early access in assisted ventilation permits earlier discharge with tracheotomy in situ.
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Affiliation(s)
- Annette H C Ang
- Department of Otolaryngology, Kandang Kerbau Women's and Children's Hospital, Singapore, Singapore.
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Añón JM, Araujo JB, Escuela MP, González-Higueras E. [Percutaneous tracheostomy in the ventilated patient]. Med Intensiva 2013; 38:181-93. [PMID: 23347906 DOI: 10.1016/j.medin.2012.11.012] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2012] [Revised: 11/21/2012] [Accepted: 11/22/2012] [Indexed: 11/25/2022]
Abstract
The medical indications of tracheostomy comprise the alleviation of upper airway obstruction; the prevention of laryngeal and upper airway damage due to prolonged translaryngeal intubation in patients subjected to prolonged mechanical ventilation; and the facilitation of airway access for the removal of secretions. Since 1985, percutaneous tracheostomy (PT) has gained widespread acceptance as a method for creating a surgical airway in patients requiring long-term mechanical ventilation. Since then, several comparative trials of PT and surgical tracheostomy have been conducted, and new techniques for PT have been developed. The use of percutaneous dilatation techniques under bronchoscopic control are now increasingly popular throughout the world. Tracheostomy should be performed as soon as the need for prolonged intubation is identified. However a validated model for the prediction of prolonged mechanical ventilation is not available, and the timing of tracheostomy should be individualized. The present review analyzes the state of the art of PT in mechanically ventilated patients--this being regarded by many as the technique of choice in performing tracheostomy in critically ill patients.
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Affiliation(s)
- J M Añón
- Servicio de Medicina Intensiva, Hospital Virgen de la Luz, Cuenca, España.
| | - J B Araujo
- Servicio de Medicina Intensiva, Hospital Virgen de la Luz, Cuenca, España
| | - M P Escuela
- Servicio de Medicina Intensiva, Hospital Virgen de la Luz, Cuenca, España
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Raju A, Joseph DK, Diarra C, Ross SE. Percutaneous versus open tracheostomy in the pediatric trauma population. Am Surg 2010; 76:276-8. [PMID: 20349656 DOI: 10.1177/000313481007600307] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The purpose of this study was to determine the safety and efficacy of percutaneous versus open tracheostomy in the pediatric trauma population. A retrospective chart review was conducted of all tracheostomies performed on trauma patients younger than 18 years for an 8-year period. There was no difference in the incidence of brain, chest, or facial injury between the open and percutaneous tracheostomy groups. However, the open group had a significantly lower age (14.2 vs. 15.5 years; P < 0.01) and higher injury severity score (26 vs. 21; P = 0.015). Mean time from injury to tracheostomy was 9.1 days (range, 0 to 16 days) and was not different between the two methods. The majority of open tracheostomies were performed in the operating room and, of percutaneous tracheostomies, at the bedside. Concomitant feeding tube placement did not affect complication rates. There was not a significant difference between complication rates between the two methods of tracheostomy (percutaneous one of 29; open three of 20). Percutaneous tracheostomy can be safely performed in the injured older child.
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Affiliation(s)
- Ashish Raju
- Department of Surgery, Division of Trauma, Cooper University Hospital and UMDNJ-Robert Wood Johnson Medical School, Camden, New Jersey, USA
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Treschan TA, Pannen B, Beiderlinden M. What’s new in Percutaneous Dilational Tracheostomy? Intensive Care Med 2009. [DOI: 10.1007/978-0-387-77383-4_31] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Baek CH, Chung YJ, Jeong HS, Kim SW. Comparison of Open Dilatational Tracheostomy with Conventional Pediatric Tracheostomy in a Growing Animal Model. Laryngoscope 2005; 115:2193-8. [PMID: 16369165 DOI: 10.1097/01.mlg.0000181655.48336.af] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVES To compare the tracheal changes after applying a new open dilatational tracheostomy (ODT) technique with those from a conventional open tracheostomy (COT) with vertical cartilage incision in a growing animal model. STUDY DESIGN Prospective, experimental investigation in a rabbit model. MATERIALS AND METHODS Thirteen New Zealand white rabbits as a pediatric model were divided into three groups: six rabbits had COT (n = 6), another six underwent an ODT (n = 6), and one rabbit acted as a control. Each rabbit underwent tracheostomy by assigned procedures on the first day. On day 8, they were decannulated. On day 15, their tracheas were harvested. We examined the gross findings and histologic changes of each tracheal segment at the stomal level. In addition, we analyzed three parameters: the quotient of the stomal and nonstomal segment in sagittal diameter, coronal diameter, and cross-sectional area. RESULTS The framework of cartilages at the stomal level were more distorted in the COT group. Histologic examination also showed buckling of the anterior tracheal wall, loss of cartilage, infiltration by many polymorphonuclear neutrophils, and the marked ingrowth of fibrous tissue in the COT group. Sagittal and coronal diameters and cross-sectional areas were significantly affected more severely after a COT than after an ODT. CONCLUSION Our new modification of percutaneous dilatational tracheostomy, named "open dilatational tracheostomy," was successfully applied to a small, growing animal model and showed more favorable and consistent healing of trachea compared with COT. Therefore, the authors' new tracheostomy procedure could be applied to children who require short-term tracheostomy at any age in clinical settings.
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Affiliation(s)
- Chung-Hwan Baek
- Department of Otorhinolaryngology-Head and Neck Surgery, Sungkyunkwan University School of Medicine, Samsung Medical Center, Seoul, Korea.
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Silvia Bárbara C, Rodríguez Núñez A, López Franco M, Martinón Torres F, Martinón Sánchez JM. [Percutaneous tracheostomy under endoscopic guidance in adolescents]. An Pediatr (Barc) 2005; 63:160-3. [PMID: 16045876 DOI: 10.1157/13077459] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Percutaneous tracheostomy (PT) is a well-established procedure in adult patients who require long-term airway control. Because experience with this procedure is scarce in pediatrics, we report the results of PT by means of a progressive dilatational method with endoscopic guidance in three critically-ill adolescents with severe head injury. PT was performed by means of the Ciaglia Blue Rhino method at the bedside, guided by fiberoptic bronchoscopy by the pediatric intensive care unit staff. No hemodynamic or respiratory compromise was observed during the procedure. No complications were attributable to PT. Two patients were decannulated without incidents. The reported cases indicate that PT can be performed safely, at least in adolescents.
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Affiliation(s)
- C Silvia Bárbara
- Istituto di Clinica Pediatrica, Policlinico Umberto I, Università La Sapienza, Roma, Italy
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Abstract
Percutaneous tracheostomy is now established in intensive care practice. However, discussion continues on many aspects of the procedure. This update reviews recent studies of bedside percutaneous tracheostomy, which suggest that the commonly used techniques are safe in terms of short and long-term complications. The introduction of percutaneous tracheostomy into an intensive care unit has training implications, particularly for surgeons. The timing of percutaneous tracheostomy in critically ill patients, and the use of the technique in children remain controversial.
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Affiliation(s)
- M Mercer
- The Intensive Care Unit, Frenchay Hospital, Bristol, BS16 1LE, UK
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New techniques and advances in tracheostomy. Curr Opin Otolaryngol Head Neck Surg 1999. [DOI: 10.1097/00020840-199906000-00009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Veyckemans F. New developments in the management of the paediatric airway: cuffed or uncuffed tracheal tubes, laryngeal mask airway, cuffed oropharyngeal airway, tracheostomy and one-lung ventilation devices. Curr Opin Anaesthesiol 1999; 12:315-20. [PMID: 17013330 DOI: 10.1097/00001503-199906000-00010] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
The use of a cuffed endotracheal tube should no longer be limited by the age of the child but by his or her clinical condition (e.g. poor lung compliance). To prevent pharyngeal damage, overinflation of the cuff of the laryngeal mask airway should be avoided by inflating it with the minimum volume required to maintain an effective seal and by monitoring intracuff pressure if nitrous oxide is used. Percutaneous tracheostomy in children is still in the experimental stage. New and older devices to perform one-lung ventilation in children are also described.
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Affiliation(s)
- F Veyckemans
- Department of Anaesthesiology, Catholic University of Louvain Medical School, Cliniques Universitaires St Luc, Avenue Hippocrate 10-1821, B 1200 Brussels, Belgium.
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