Tracheostomies were performed mostly in very small children and comorbidities were very common. Once a tracheostomy was performed in a child in most cases it was not removed before a year. The most common early complication was stoma infection followed by accidental decannulation. The most frequent late complication was granuloma and suprastomal collapse. Airway abnormalities were very frequent in this population and therefore need to be assessed before attempting decannulation.
BackgroundDetermining prognostic factors for the probability of tracheostomy decannulation is key to an adequate therapeutic plan.MethodsA retrospective cohort study of 160 paediatric patients undergoing tracheostomy was conducted. Associations between different parameters and eventual tracheostomy decannulation were assessed.ResultsMean follow-up duration was 27.8 months (interquartile range = 25.5–30.2 months). Median age at tracheostomy was 6.96 months (interquartile range = 3.37–29.42 months), with median tracheostomy maintenance of 14.5 months (interquartile range = 3.7–21.5 months). The overall tracheostomy decannulation rate was 22.5 per cent. Factors associated with a higher probability of tracheostomy decannulation included age at tracheostomy (hazard ratio = 1.11, 95 per cent confidence interval = 1.03–1.18) and post-intubation laryngitis as an indication for tracheostomy (hazard ratio = 2.25, 95 per cent confidence interval = 1.09–4.62). Neurological (hazard ratio = 0.30, 95 per cent confidence interval = 0.12–0.80) and pulmonary (hazard ratio = 0.41, 95 per cent confidence interval = 0.18–0.91) co-morbidities were negatively associated with tracheostomy decannulation. The probability of tracheostomy decannulation decreased significantly with increasing numbers of co-morbidities (p < 0.001).ConclusionAge, post-intubation laryngitis, and number and type of co-morbidities influence tracheostomy decannulation rate in the paediatric population.
This study was designed to determine whether infants generate sufficient inspiratory pressure gradient to open the unidirectional valve of various commercially available holding chambers, as well as the time required to reach this gradient. A prospective, cross-sectional study was performed of 80 healthy infants (aged 1-24 months) seen in the childcare outpatient clinic of a pediatric hospital, from October to December of 2007. Using the same inhalation technique recommended for treatment of respiratory diseases and asthma in this age group, four holding chambers were analyzed: Flumax Baby, AlergoChamber, LuftChamber, and ACE (n = 20 infants per analysis group). The variables measured were gradient of inspiratory pressure and time for the valve to open. The holding chambers did not differ in gradient of inspiratory pressure (p = 0.382) or time to open the valve (p = 0.199). Fifteen of 80 infants were not able to generate sufficient inspiratory pressure to open the valve (1 using AlergoChamber, 5 using Flumax Baby, 6 using ACE, and 3 using LuftChamber), with no significant differences between devices. The holding chambers were similar regarding pressure gradient and time required to open the valve. The fact that 19% of the sample was unable to open the valve suggests that it would be useful to determine the ability of small children (<24 months of age) to use holding chambers before prescribing them.
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