Pediatric tracheotomy: 17 year review

Mahadevan, Murali; Barber, Colin; Salkeld, Lesley; Douglas, Gavin; Mills, Nikki

doi:10.1016/j.ijporl.2007.08.007

Cited by 186 publications

(235 citation statements)

References 16 publications

(32 reference statements)

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“…However this was higher than the study by Mahadevan who reported a recannulation rate of 6.5 % [10].…”

Section: Discussioncontrasting

confidence: 65%

“…Cochrane and Bailey recommended assessments like laryngoscopy and bronchoscopy at decannulation [1]. Mahadevan et al found that most of their subjects were successfully decannulated (75 %) with a recannulation rate of only 6.5 % following pre-decannulation bronchoscopy and concluded that their policy of performing bronchoscopy prior to decannulation with subsequent decannulation performed in the ICU has contributed to their high decannulation success rate [10]. Yellon recommends performing routine interval direct laryngoscopy and bronchoscopy in children with tracheostomies approximately once every 4 months, when problems occur and prior to decannulation [11] and treating any granuloma or suprastomal collapse after which the subject can be decannulated in the ward.…”

Section: Introductionmentioning

confidence: 99%

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Pre-decannulation Peristomal Findings in Tracheostomized Cases and Their Effect on the Success of Decannulation

Mathur

Sohliya

2014

Indian J Otolaryngol Head Neck Surg

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Decannulating a patient on a tracheostomy is a procedure that has to be dealt with vigilantly. This study evaluated both external and telescopic/bronchoscopic findings at the peristomal level of subjects being considered for decannulation. The patients did not undergo any intervention after above observations and before attempting decannulation. Thereafter peristomal findings and their contribution towards failure to decannulate were correlated. Thirty subjects were studied prospectively, of whom 21 (70 %) demonstrated peristomal complications including granulation tissue, ulceration, mucopurulent discharge, suprastomal granulations, suprastomal collapse and suprastomal flap. Complications were more common in the younger age group (p = 0.007) as well as in tracheostomies of longer duration with mean duration [20 months (p = 0.045). However there was no statistically significant correlation between the success of decannulation and various peristomal findings. Therefore the success of decannulation in a particular case cannot always be correctly predicted by peristomal assessment.

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“…However this was higher than the study by Mahadevan who reported a recannulation rate of 6.5 % [10].…”

Section: Discussioncontrasting

confidence: 65%

Section: Introductionmentioning

confidence: 99%

Pre-decannulation Peristomal Findings in Tracheostomized Cases and Their Effect on the Success of Decannulation

Mathur

Sohliya

2014

Indian J Otolaryngol Head Neck Surg

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“…Later, the wide use of vaccination programmes, mainly against Corynebacterium diphtheriae and Haemophilus influenzae, together with the development of new anaesthetic materials and techniques to stabilise the upper airway, spectacularly reduced the number of emergent procedures in most series [1][2][3][4]. Nevertheless, despite these advances, the incidence of tracheostomy in children has not fallen; indeed, it has even risen in some hospitals [5][6][7][8]. This has been attributed to increased survival of assisted patients in paediatric and neonatal intensive care units (ICUs), with the progressive appearance of what has been termed the ''technology-dependent paediatric patient'' [9], referring mainly to children on long-term assisted ventilation, or with congenital or acquired upper airway anomalies.…”

mentioning

confidence: 99%

Paediatric patients with a tracheostomy: a multicentre epidemiological study

Pérez-Ruíz¹,

Caro²,

Pérez‐Frías³

et al. 2012

Eur Respir J

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Changes in the indications for tracheostomy in children have led to the progressively greater involvement of the paediatric pulmonologist in the care of these patients. The aim of this study was to review the current profile of tracheostomised children in Spain.We undertook a longitudinal, multicentre study over 2 yrs (2008 and 2009) of all patients aged between 1 day and 18 yrs who had a tracheostomy.The study, involving 18 Spanish hospitals, included 249 patients, of whom 150 (60.2%) were ,1 yr of age. The main indications for the procedure were prolonged ventilation (n5156, 62.6%), acquired subglottic stenosis (n534, 13.6%), congenital or acquired craniofacial anomalies (n525, 10%) and congenital airway anomalies (n524, 9.6%). The most frequent underlying disorders were neurological diseases (n5126, 50.6%) and respiratory diseases (n598, 39.3%). Over the 2-yr study period, 92 (36.9%) children required ventilatory support, and decannulation was achieved in 59 (23.7%). Complications arose in 117 patients (46.9%). Mortality attributed to the underlying condition was 12.5% and that related directly to the tracheostomy was 3.2%.Respiratory complexity of tracheostomised children necessitates prolonged, multidisciplinary follow-up, which can often extend to adulthood.

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“…After the diagnosis of JXG, the tumors regressed spontaneously in both cases during long-term observation of the remnant tumors. Because recurrence of JXG is rare and spontaneous regression can be expected, the four recently reported patients including the present one were managed by laryngomicrosurgery for tumor reduction without tracheotomy, and this strategy had the merit of avoiding complications of pediatric tracheotomy, for example,subglottic stenosis and bleeding with local granulation (Mahadevan et al 2007). However, in children with severe airway narrowing that makes endotracheal intubation difficult, prompt therapy with tracheotomy should be performed without hesitation.…”

Section: Discussionmentioning

confidence: 90%

Isolated Juvenile Xanthogranuloma in the Larynx of a Three-Year-Old Child

Kawamoto

Katori

Honkura

et al. 2013

Tohoku J. Exp. Med.

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Juvenile xanthogranuloma (JXG) is a benign manifestation of non-Langerhans cell histiocytosis characterized by yellowish cutaneous nodules. Its occurrence in the larynx is very rare, but laryngeal JXG may cause severe respiratory distress. We report a patient with isolated laryngeal JXG treated by laryngomicrosurgery, and this is the first report of JXG extending to vocal fold. A 3-year-old girl presented with hoarseness and inspiration stridor. A bulky tumor was found in right glottic to subglottic region. Subtotal resection of the tumor was carried out by laryngomicrosurgery, and airway distress was diminished after the operation. In pathological examination, the resected specimen showed proliferation of histiocytic cells and spindle cells with Touton giant cells that are characterized by polynuclei or wreath nuclei and are known to appear in JXG but not in LCH. Immunohistochemistry of histiocytic cell markers demonstrated positivity for CD68, lysozyme, alpha1-anti-chymotrypsin, factor XIIIa and vimentin, and negativity for CD1a and S-100, leading to diagnosis of JXG, but not LCH. The patient was thus expected with benign prognosis, and additional resection of the tumor including vocal fold was not indicated in the initial treatment. Six weeks later, the JXG recurred and a second procedure using CO 2 laser was needed. The tumor did not re-grow thereafter, and there was no residual voice handicap. Because of its favorable prognosis and tendency for spontaneous regression, JXG in the larynx needs to be considered carefully with regard to whether reduction surgery and/or tracheotomy are necessary, and thus precise diagnosis is required.

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Pediatric tracheotomy: 17 year review

Cited by 186 publications

References 16 publications

Pre-decannulation Peristomal Findings in Tracheostomized Cases and Their Effect on the Success of Decannulation

Pre-decannulation Peristomal Findings in Tracheostomized Cases and Their Effect on the Success of Decannulation

Paediatric patients with a tracheostomy: a multicentre epidemiological study

Isolated Juvenile Xanthogranuloma in the Larynx of a Three-Year-Old Child

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