4 Pediatric tracheotomy: changing trends in Puerto Rico.
Subject: Pediatria (Historia)
Pediatria (Analisis de casos)
Traqueotomia (Investigacion cientifica)
Traqueotomia (Analisis de casos)
Pub Date: 06/01/2009
Publication: Name: Puerto Rico Health Sciences Journal Publisher: Universidad de Puerto Rico, Recinto de Ciencias Medicas Language: Spanish Audience: Academic Format: Magazine/Journal Subject: Health Copyright: COPYRIGHT 2009 Universidad de Puerto Rico, Recinto de Ciencias Medicas ISSN: 0738-0658
Issue: Date: June, 2009 Source Volume: 28 Source Issue: 2
Geographic: Geographic Name: Puerto Rico
Accession Number: 201212353
Full Text: 4 Pediatric Tracheotomy: Changing Trends in Puerto Rico. Melissa Ortiz MD, Yadiel Alameda MD, Javier Gonzalez MS, Carlos Gonzalez-Aqui no MD, FACS; Division of Otolaryngology-Head and Neck Surgery, University of Puerto Rico, Medical Sciences Campus, San Juan, Puerto Rico.

Introduction: A study was done to understand changing trends in the indications and decannulation rates for pediatric tracheotomy and to propose recommendations for the coordinated care of children with tracheotomy. Methods: A retrospective chart review of 189 patients undergoing tracheotomy, between 1991 and 2007, was done at San Jorge Children's Hospital, San Juan, Puerto Rico. There were 189 patients under 17 years of age who underwent tracheotomy. Sufficient data was available on 171 children. The data was tabulated for age, diagnosis, complications, and outcome. Patients were divided in groups based on the indication for tracheotomy. Results: A total of 189 tracheotomies were performed between 1991 and 2007. Sufficient data was available on 171 patients. The average age at the time of tracheotomy was 40 months, with a range of 2 days--296 months and mean time of follow-up was 33 months. Unfortunately, 49 patients were lost to follow-up. Five groups were identified based on the primary indication for tracheotomy and decannulation rates were calculated for each: true vocal cord paralysis in 10 patients (6%) with 30% decannulation rate, airway obstruction in 29 patients (17%) with 90% decannulation rates, craniofacial malformation in 17 patients (10%) with a 23% decannulation rate, neurological impairment in 85 patients (50%) with a 1 % decannulation rate, and prolonged mechanical ventilation in 30 patients (18%) with a 10% decannulation rate. We report no intraoperative complications, a 19% overall complication rate, and a 9% mortality not directly related to the tracheotomy procedure. The majority of patients lost to follow-up were in the prolonged mechanical ventilation, and neurological impairment groups. Conclusions: Over the last decades the indications for tracheotomy have shifted toward children with underlying neurological impairment and need for prolonged mechanical ventilation. Decannulation rates for these children are significantly lower (approximately 1 and 10%, respectively) than for children with obstructive airway pathology (90%). The neurological impairment and prolonged mechanical ventilation groups also had more loss to follow-up (29 and 50% respectively) than the obstructive airway pathology group (7%). Therefore, the care of these children and their tracheotomies will require long-term coordinated multidisciplinary settings. We present recommendations to achieve this goal.
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