Paediatric tracheostomy tubes: recent developments and our current practice

Tweedie, D.J.; Cooke, Jo; Stephenson, Kate; Gupta, Sanjeev; Pepper, Chris; Elloy, M; Cochrane, Lesley; Wyatt, Michelle

doi:10.1017/s0022215118001330

Cited by 17 publications

(11 citation statements)

References 5 publications

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“…Because most TEFs are located near the carina, a regular tracheostomy tube that extends only to the middle trachea may not prevent the collapse of the lower trachea. Therefore a custom made tube that extends to the lower trachea may be necessary (these tubes may also provide enough stenting of the main stem bronchii) 142 .…”

Section: Recommendations On Therapeutic Interventions VII Management Of Tracheobronchomalaciamentioning

confidence: 99%

Care Recommendations for the Respiratory Complications of Esophageal Atresia-Tracheoesophageal Fistula: The International Network of Esophageal Atresia, Respiratory Complications Working Group

Koumbourlis

Belessis

Cataletto

et al. 2020

Preprint

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Tracheoesophageal fistula (TEF) with esophageal atresia (EA) is a common congenital anomaly that is associated with significant respiratory morbidity throughout life. The objective of this document is to provide a framework for the diagnosis and management of the respiratory complications that are associated with the condition. As there are no randomized controlled studies on the subject, a group of experts used a modification of the Rand Appropriateness Method to describe the various aspects of the condition in terms of their relative importance, and to rate the available diagnostic methods and therapeutic interventions on the basis of their appropriateness and necessity. Specific recommendations were formulated and reported as Level A, B, C based on whether they were based on "strong", "moderate" or "weak" agreement. The tracheomalacia that exists in the site of the fistula was considered the main abnormality that predisposes to all other respiratory complications due to airway collapse and impaired clearance of secretions. Aspiration due to impaired airway protection reflexes is the main underlying contributing mechanism. Flexible bronchoscopy is the main diagnostic modality, aided by imaging modalities, especially CT scans of the chest. Non-invasive positive airway pressure support, surgical techniques such as tracheopexy and rarely tracheostomy are required for the management of severe tracheomalacia. Regular long-term follow-up by a multidisciplinary team was considered imperative. Specific templates outlining the elements of the clinical respiratory evaluation according to the patients' age were also developed.

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Section: Recommendations On Therapeutic Interventions VII Management Of Tracheobronchomalaciamentioning

confidence: 99%

Care Recommendations for the Respiratory Complications of Esophageal Atresia-Tracheoesophageal Fistula: The International Network of Esophageal Atresia, Respiratory Complications Working Group

Koumbourlis

Belessis

Cataletto

et al. 2020

Preprint

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“…Clinicians face two major problems: relatively limited, imprecise, or incomplete data about pediatric airway size, and difficulty of airway size assessment in current clinical practice. Thereby, many of the decisions made in these fields rely on the physician's experience or calculations and extrapolations from age, weight, or finger size . In the era of evidenced‐based medicine, it seems important to complement this valuable experience with precise measurements of the pediatric airway based on a large number of parameters, on a large cohort and correlated to biometric data …”

Section: Introductionmentioning

confidence: 99%

Developmental changes of upper airway dimensions in children

Luscan

Leboulanger

Fayoux

et al. 2020

Pediatric Anesthesia

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Background: Knowledge about airway dimensions during child growth is of paramount importance for pediatric clinical practice. Decisions about airway management in children are based on relatively limited, imprecise, or incomplete data about airway size. Aims:The aim of this work was to determine the anatomical development and size of airway structures from birth to adolescence using high-resolution computed tomography scans and to study the correlation between airway measurements and biometric data. Methods:We conducted a retrospective study of all high-resolution computed tomography scans including the respiratory tract, performed in our tertiary pediatric center (for reasons unrelated to airway symptoms) between June 1, 2016, and October 15, 2017, on children aged from 1 day to 14 years old. On each scan, 23 measurements of the larynx, trachea, and mainstem bronchi were performed.Patients were stratified into 16 groups according to their age. We calculated median value for each measurement in each group. Statistical models were calculated to explore correlation between measurements and age or weight. Results:A total of 192 scans were included (127 boys/65 girls). The mean age was 7 years. The correlations between airway measurements and age or weight were always significant. The relationship between measurements and age was found to be suitably represented by a cubic polynomial equation suggesting that the airway has a rapid growth phase in the first 3 years, followed by a slow growth phase and a second rapid growth phase during adolescence. The most relevant biometric parameter was age concerning 21 of the measurements. Conclusion:This comprehensive anatomical database of upper airway dimensions provides important data in the field of pediatric airway anatomy, particularly relating to the cricoid. We demonstrated that laryngeal, tracheal, and bronchial parameters correlate better to age and have three different growth phases. K E Y W O R D Sage, dimensions, endotracheal tube, pediatric airway, weight

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“…The long‐term increases in airway diameter found in this study were not compared with the increases expected due to natural growth; however, the natural history of progression of airway stenosis is not well understood. It cannot be assumed that stenosis will progressively widen with the general growth of the child.…”

Section: Discussionmentioning

confidence: 65%

“…Efficacy outcome measures were as follows: intra‐operative change in airway diameter (millimetres) and Cotton‐Myer grade directly before and after the balloon dilatation intervention. Cotton‐Myer grade was calculated using the measured airway diameter compared with an age‐related healthy cricoid anteroposterior diameter . In the absence of a measured airway diameter, Cotton‐Myer grade was estimated by the treating clinician.…”

Section: Methodsmentioning

confidence: 99%

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Balloon dilatation for paediatric airway stenosis: Evidence from the UK Airway Intervention Registry

Powell

Keltie

Burn

et al. 2020

Clinical Otolaryngology

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Objectives:To assess the safety and efficacy in routine clinical practice of balloon dilatation procedures in the treatment of paediatric airway stenosis.Design: Observational data collection in prospective online research database.Setting: Acute NHS Trusts with ENT department undertaking complex paediatric airway work.Participants: Children (<18) undergoing balloon dilatation treatment for airway stenosis. Main outcome measures: Airway diameter, complications, hospital resource usage.Results: Fifty-nine patients had 133 balloon procedures during 128 visits to 10 hospitals. Sixty-nine (52%) of balloon procedures were conducted with a tracheostomy.Intra-operative Cotton-Myer grade decreased in 43 (57%). The mean pre-balloon subglottic diameter was 4.2 [95% CI: 3.8 to 4.5] mm, and its rate of increase was 0.8 [0.5 to 1.2] mm per year modelled on 30 patients' long-term data. As the primary treatment of stenosis, the procedural success rate of balloon dilatation (n = 52) was 65% (22% with tracheostomy, 88% without tracheostomy), and 71% as an adjunct to open reconstructive surgery (n = 7). In the 64 hospital visits where a balloon procedure was conducted with a tracheostomy in place, only one in-hospital complication (lower respiratory tract infection) occurred. For those without a tracheostomy in place, inhospital complications occurred in seven of 64 balloon hospital visits, all related to ongoing or worsening stenosis. Six out-of-hospital complications were deemed related to ongoing or worsening stenosis following the procedure, and two complications were a combination of lower respiratory infection and ongoing or worsening stenosis. Conclusions: Balloon dilation increases the size of the airway intraoperatively andis associated with long-term increase in airway diameter. Safety outcomes mostly relate to ongoing or worsening stenosis and are more common in patients without a tracheostomy.This is an open access article under the terms of the Creative Commons Attribution-NonCommercial License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited and is not used for commercial purposes.

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Paediatric tracheostomy tubes: recent developments and our current practice

Cited by 17 publications

References 5 publications

Care Recommendations for the Respiratory Complications of Esophageal Atresia-Tracheoesophageal Fistula: The International Network of Esophageal Atresia, Respiratory Complications Working Group

Care Recommendations for the Respiratory Complications of Esophageal Atresia-Tracheoesophageal Fistula: The International Network of Esophageal Atresia, Respiratory Complications Working Group

Developmental changes of upper airway dimensions in children

Balloon dilatation for paediatric airway stenosis: Evidence from the UK Airway Intervention Registry

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