Document Detail


Indications for tracheotomy in the pediatric intensive care unit population: a pilot study.
MedLine Citation:
PMID:  12431164     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
OBJECTIVE: To define the indications for tracheotomy in patients requiring prolonged intubation (>1 week) in the pediatric intensive care unit (PICU). DESIGN: Retrospective chart review and follow-up telephone survey. SETTING: A tertiary care center PICU. OUTCOME MEASURE: Tracheotomy or extubation. PATIENTS: All patients older than 30 days in the PICU intubated for longer than 1 week between 1997 and 1999. RESULTS: During the study, 63 total admissions required intubation for longer than 1 week. A tracheotomy was necessary in 14% of admissions (n = 9). The mean length of intubation before the tracheotomy was 424 hours, whereas the mean length of intubation without the need for tracheotomy was 386 hours. Length of intubation, age, and number of intubations did not increase the probability of having a tracheotomy. Of those requiring a tracheotomy, 2 had tracheomalacia, 1 had subglottic edema, 1 had plastic bronchitis, 1 had Down syndrome with apnea resulting in right heart failure, 3 required long-term ventilation after cardiopulmonary collapse, and 1 had mitochondrial cytopathy. Of these 9 children, 7 were successfully decannulated, 1 patient died of underlying disease, and 1 patient remained cannulated secondary to the mitochondrial cytopathy. Twenty families of the patients who did not undergo a tracheotomy were reached by telephone after discharge. Most of the families reported that their children were free of stridor and hoarseness after extubation. CONCLUSIONS: Children tolerate prolonged intubation without laryngeal complications. The consideration for tracheotomy in the PICU setting must be highly individualized for each child.
Authors:
Walter Lee; Peter Koltai; A Marc Harrison; Elumalai Appachi; Demetrios Bourdakos; Steve Davis; Kathryn Weise; Michael McHugh; Jason Connor
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Publication Detail:
Type:  Comparative Study; Journal Article    
Journal Detail:
Title:  Archives of otolaryngology--head & neck surgery     Volume:  128     ISSN:  0886-4470     ISO Abbreviation:  Arch. Otolaryngol. Head Neck Surg.     Publication Date:  2002 Nov 
Date Detail:
Created Date:  2002-11-14     Completed Date:  2002-12-09     Revised Date:  2006-11-15    
Medline Journal Info:
Nlm Unique ID:  8603209     Medline TA:  Arch Otolaryngol Head Neck Surg     Country:  United States    
Other Details:
Languages:  eng     Pagination:  1249-52     Citation Subset:  AIM; IM    
Affiliation:
Department of Otolaryngology, Section of Pediatric Otolaryngology, The Cleveland Clinic Foundation, OH 44195, USA.
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MeSH Terms
Descriptor/Qualifier:
Airway Obstruction / diagnosis,  mortality,  surgery*
Child, Preschool
Confidence Intervals
Critical Care / methods
Female
Follow-Up Studies
Health Care Surveys
Humans
Infant
Intensive Care Units, Pediatric
Intubation, Intratracheal / mortality,  statistics & numerical data*
Male
Ohio
Pilot Projects
Prevalence
Reference Values
Retrospective Studies
Risk Assessment
Survival Analysis
Time Factors
Tracheotomy / methods,  mortality*,  statistics & numerical data*
Treatment Outcome

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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