Tracheostomy In Children Research Articles

Paediatric tracheostomy

Fifty-seven operations on 53 patients represents the total experience of tracheostomy in children under 13 years during 1964-1985 in an area with half a million inhabitants. No complication occurred during surgery and no deaths were related to the operations. Complications followed 16 out of 30 (53%) operations on children under three years and four out of 27 (15%) of the remainder, an overall complication rate of 35%. Many fewer operations have been required since 1973 because of the successful employment of nasotracheal intubation in the treatment of upper and lower airway obstruction caused by acute infection. Obstruction by-pass remains the commonest function of tracheostomy, with congenital lesions and trauma now the commonest causes of obstruction as opposed to acute infection in the earlier years. Despite the successful use of nasotracheal intubation there were absolute indications for tracheostomy--blockage of the nasotracheal tube; inability to intubate a child with epiglottitis; and necessity for an artificial airway of long duration.

Pulmonary edema complicating relief of upper airway obstruction

Treatment by endotracheal intubation or tracheostomy in children with severe and prolonged upper airway obstruction usually results in dramatic improvement; in some rare instances, it is complicated by the development of pulmonary edema. During an eight-year period, the author observed this complication in 20 children. The mechanism of this edema is complex and not yet fully understood. In addition to hypoxia, profound hemodynamic changes occur during the inspiratory phase of the obstruction; highly negative transpulmonary pressure may lead to an increase in pulmonary blood volume and biventricular dysfunction, and possibly disruption of integrity of the pulmonary endothelium. These hemodynamic changes appear to be counterbalanced by the positive pleural and alveolar pressures and decreased venous return during the expiratory component of the obstruction. Nevertheless, when an artificial airway is inserted, this compensation is disrupted abruptly, resulting in an increase in systemic venous return and thus pulmonary edema. Although this type of edema usually is observed in cases of severe obstruction, it may go unrecognized or misdiagnosed.

Alternative Treatment to Tracheostomy in Obstructive Sleep Apnea Syndrome: Nasal Continuous Positive Airway Pressure in Young Children

Two groups of prepubertal children with severe obstructive sleep apnea syndrome received continuous positive airway pressure (CPAP) treatment using a nasal mask. The five children in group A had nasal CPAP only in a hospital setting; the five children in group B received the treatment at home as well. Four of these five children, who have now been followed for as long as 10 months, have adapted well to the treatment at home. The problems encountered with nasal CPAP as a home treatment, such as poor cooperation from parents, allergic rashes, eye irritation resulting from air leaks, are discussed. Despite the problems, nasal CPAP is a valid alternative to tracheostomy in children as young as 3 years of age.

Tracheostomy in children

One hundred children who had tracheostomy done for various indications have been reviewed. It has been found that in spite of advent of mosotracheal intubation, there are still certain indications for tracheostomy in children. Various complications of the tracheostomy have been analysed in the light of other studies available. Decannulation problem has been discussed with special references. It is found that wherever the primary disease warrants it, decannulation of tracheostomy must be done as early as possible and if found difficult, decreasing sized tracheostomy tube insertion is to be resorted to.

Sp�tfolgen der Tracheotomie bei Kindern

Tracheostomy in children has become less frequent in the course of the last years. Especially in the opinion of paediatricians tracheostomy is a dangerous and nowadays obsolete surgical intervention often followed by complications.

Stenosing processes due to endotracheal intubation and tracheostomy in children

In 1976–1978 there were 15 children hospitalized in the Children's ORL Clinics in Prague and treated for larynx trauma caused by long-term endotracheal intubation. Tracheostomy was performed in all cases, the changes in the larynx were mostly treated in a conservative manner. In one instance we used laryngofissura; however, further dilatations had be carried out. With a single exception, all the patients have been healed successfully. Plastic operations were performed to make decannulation easier.

Does tracheostomy in children retard the growth of trachea or larynx?

Tracheostomy in children has been reported to cause tracheal stenosis, laryngeal stenosis and subsequent difficulties in decannulation. No long term follow-up studies appear to be in the literature describing the events following decannulation. This study compared the radiological size of the cricoid and tracheal lumens with that of normals. Except in special cases tracheostomy did not affect the subsequent growth of the trachea or cricoid. It is suggested that traumatic tracheal narrowing in children should be managed conservatively.

Letter: Defense of tracheostomy in children.

To the Editor.— I read with concern the CLINICAL NOTE, Death Precipitated by Tracheostomy in a Child (231:277, 1975) by Drs. Schmidt, Bennett, and Dalai. The pneumomediastinum in the 12-month-old drowning victim was most likely secondary to pulmonary interstitial emphysema due to high mechanical ventilating pressures of 70 to 80 cm H 2 O combined with 8 cm of positive end expiratory pressure, as may be seen in the newborn with the respiratory distress syndrome. Mediastinal air under tension usually decompresses spontaneously by rupturing into the pleural cavity, producing a treatable pneumothorax and relieving venous air block. 1 Cardiac air tamponade due to intrapericardial air may also develop and is improved by pericardiocentesis. 2 We have also successfully aspirated other localized collections of extrapleural air with small plastic catheters, but have not considered it wise to attempt decompression by surgical incision. As stated by the authors, a tracheostomy with its

THE USE OF JACKSON REES TUBES AS TRACHEOSTOMY TUBES IN CHILDREN

SUMMARY Three case histories are presented in which special difficulties were encountered in the management of tracheostomies in children. These problems were overcome by the use of a shortened Jackson Rees tube inserted into the tracheostome.

THE CRITICALLY ILL CHILD: MANAGEMENT OF TRACHEOSTOMY

The indications for and methods of performing a tracheostomy in children are many and varied. There is still controversy as to the size, types, and placement of the tube; the type of incision; the relative indications for tracheostomy in infants and older children; the use of prolonged endotracheal intubation in preference to tracheostomy; and even the type of instruments used to perform the tracheostomy. However, problems discussed here are mainly the proper care of the child with a tracheostomy tube, including those associated with its removal. Whatever the disease state from which the child suffers, certain basic principles must be kept in mind during all tracheostomy care. These relate to: (1) inspired gas mixtures, (2) humidification in inspired gas, (3) suctioning of secretions, (4) positive pressure breathing, (5) chest physiotherapy, (6) weaning of a patient from tracheostomy, (7) home care of tracheostomy by parent, and (8) complications of tracheostomy. Let us now examine these factors in detail. INSPIRED GAS MIXTURES Gas mixtures most commonly administered via tracheostomy are of oxygen and air, in percentage that will maintain arterial oxygen tension (PaO2) at near normal. Sometimes this will require 100% oxygen or sometimes 100% air, which is, of course, 20% oxygen. Whatever the mixture, the PaO2 should never exceed 250 mm Hg; ideally, it should never approach this figure. Immediately following tracheostomy, arterial blood gases should be measured with the patient breathing room air, providing that his clinical condition will tolerate this minimal oxygen percentage. If by clinical judgment additional oxygen is required, the inspired percentage should be carefully measured at the time blood is drawn for gas determination.

Tracheostomy in children with croup: a retrospective study of the mortality and morbidity at the Hartford Hospital.

1. Of 373 cases of croup, 6.9 per cent were operated on with a mortality of 7.6 per cent and morbidity of 11.5 per cent. 2. There is a great need for careful, constant evaluation of the child with croup and prompt operation should fatigue, irritability, and increasing pulse rate develop. 3. Endotracheal intubation should be carried out as the initial emergency step. 4. Tracheostomy should be performed in the operating room with adequate anaesthesia, assistance, exposure, and time. 5. We do not feel there is an indication at our hospital for changing to prolonged nasotracheal intubation in the treatment of upper airway respiratory distress, and we would recommend that other hospitals similar to ours evaluate their existing results prior to changing.

Tracheostomy in children: The use of plastic tubes

Experience with plastic tracheostomy tubes suggests specific advantages in managing the problems associated with tracheostomy in infants and children. A technic of tracheostomy adapted to the infant is described, and the use of tracheal stay sutures for controlled tube insertion is emphasized. Experience with 62 cases is the background for this report.

Prolonged oro-naso-tracheal intubation in children.

The maximal period allowed for oro-or nasotracheal intubation without much risk for laryngeal damage has previously been recognised as 24 hours. This conclusion was based on investigations that do not seem to have properly evaluated such factors as laryngeal activity during the period of intubation, material and size of tube, general condition and fluid balance of the patient and finally measures to prevent undue movements of the tube.In 1962 Brandstater reported the use of oro- or nasotracheal intubation in infants over periods far in excess of 24 hours and without a high incidence of laryngeal damage. Many groups have later used this methods as an alternative to tracheostomy in children. Although different technical recommendations have been given they all have in common: suppression of laryngeal motor activity and avoidance of a tube-diameter that does not easily fit the larynx and trachea. Humidification must be optimal in order to avoid sticky secretions and blocking of the tube. This method of prolo...

PATHOLOGY OF LOW TRACHEOSTOMY IN CHILDREN.

PATHOLOGY OF LOW TRACHEOSTOMY IN CHILDREN.

Anaesthesia for Tracheostomy in Children

Anaesthesia for Tracheostomy in Children

Anaesthesia for Tracheostomy in Children

Anaesthesia for Tracheostomy in Children

Anaesthesia for Tracheostomy in Children

Anaesthesia for Tracheostomy in Children

ELECTIVE TRACHEOSTOMY IN INFANTS AND CHILDREN

Abstract Elective tracheostomy in children may be performed with safety if the surgeon is thoroughly acquainted with the anatomy of the region and the occasional anomalous situation. Practically all tracheostomy tubes in use today for children and infants are excessive in length. These unanatomical tubes should be revised for use in children between the ages of the newborn to twelve years, and in no instance should they be longer than 5.5 cm. The 90 degree tube, although unsatisfactory in some instances, still possesses the best arc. The tracheostomy tube should be of a smaller diameter than the trachea. Serious consideration must be given to the performance of an elective tracheostomy in the following situations: (1) when there has been a difficult endotracheal intubation; (2) in surgery about the pharynx, larynx, tongue or mandible, when permanent or temporary respiratory obstruction may be a consequence; (3) in prolonged comatose states; and (4) in trauma to the respiratory tract or lungs, such as in a burn, when efficient respiratory toilet is essential. Proper equipment set up conveniently in trays and including Y-tubes and marked catheters must be on hand at all times. It is only by such continued and diligent attention to detail, as has been described, that the tragedies so frequently associated with this procedure may be averted.

Elective tracheostomy in infants and children

Elective tracheostomy in children may be performed with safety if the surgeon is thoroughly acquainted with the anatomy of the region and the occasional anomalous situation. Practically all tracheostomy tubes in use today for children and infants are excessive in length. These unanatomical tubes should be revised for use in children between the ages of the newborn to twelve years, and in no instance should they be longer than 5.5 cm. The 90 degree tube, although unsatisfactory in some instances, still possesses the best arc. The tracheostomy tube should be of a smaller diameter than the trachea. Serious consideration must be given to the performance of an elective tracheostomy in the following situations: (1) when there has been a difficult endotracheal intubation; (2) in surgery about the pharynx, larynx, tongue or mandible, when permanent or temporary respiratory obstruction may be a consequence; (3) in prolonged comatose states; and (4) in trauma to the respiratory tract or lungs, such as in a burn, when efficient respiratory toilet is essential. Proper equipment set up conveniently in trays and including Y-tubes and marked catheters must be on hand at all times. It is only by such continued and diligent attention to detail, as has been described, that the tragedies so frequently associated with this procedure may be averted.