DOZ047.85: Percutaneous tracheostomy guided by endoscopy in pediatric patients

Abstract

Abstract Objective Tracheostomy is one of the most frequently performed surgical procedures in chronically ill pediatric patients and mechanical ventilatory assistance. This study presents our experience in percutaneous tracheostomy (PT) guided by endoscopy in children. Methodology A retrospective descriptive analysis was carried out in which the PT guided by endoscopy from December 2010 to October 2017 at Pediatric Surgery Service of the Hospital Italiano de Buenos Aires were considered. The variables analyzed were age, gender, basic pathology, tracheostomy indication, size of the cannula placed, surgical complications, and follow-up. At the same time, an updated bibliographical search on the subject was carried out. All the parents of the patients gave written consent. Results and Discussion A total of 50 PT guided by endoscopy were performed. The average age was 9.4 years (05–19 years). The male/female ratio was 1 (25 men, 25 women). The tracheostomy indications were prolonged orotracheal intubation (n: 41), lack of airway protection (n: 4), laryngomalacia (n: 2), difficult airway (n: 2), and laryngotracheal stenosis (n: 1). The endoscopic findings include glottic lesion, subglottic stenosis, vocal cord injury, and tracheal lesions by decubitus. There were no intraoperative complications. The average surgical time was 44 minutes (r: 10–60 min). The rate of postoperative complications was 6% (n: 3), among which were accidental decannulation, desaturation, and leakage. Distant complications such as tracheitis or granulomas occurred in 8% of patients (n: 4). The definitive decannulation was achieved in 19 patients in an average time of 15 days. Conclusions PT is feasible in children with a margin of safety comparable to tracheostomy by conventional technique. Simultaneous endoscopic vision is recommended for the control of complications during the procedure, in part because it offers firmness to the anterior wall of the trachea. At the same time it allows us to diagnose preexisting laryngotracheal lesions or anomalies. The size of the tracheostomy kit should be adjusted to the age of the patient to perform a safe tracheostomy. Due to the small diameter of the trachea and its weakness, it is not recommended by us to perform percutaneous tracheostomy in patients under 2 years of age.