Document Detail


Tracheostomy in neonates and small infants: problems and pitfalls.
MedLine Citation:
PMID:  7221896     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
Newborn babies and small infants who require tracheostomy often follow a complicated clinical course characterized by frequent sepsis, altered ventilatory dynamics, and eventual respiratory decompensation. Many of these problems are avoidable with use of a properly placed endotracheal tube during tracheostomy, a special surgical technique in the performance of the tracheostomy, and silicone rubber tracheostomy tubes. Seventy-four babies underwent tracheostomy at our Children's Center between 1963 and 1976. A review of this experience demonstrates the benefits of unhurried, standardized technique and management. In the 48 newborns requiring tracheostomy, no technical difficulties were encountered, and no complications occurred as a result of the tracheostomy. In the group of 26 older infants, however, there were significant complications, especially in children undergoing emergency tracheostomy without a previously placed endotracheal tube. Although there were no deaths directly related to tracheostomy, one case of pirulent tracheitis and one case of interstitial thyroid hemorrhage were noted at autopsy. Among survivors, there was one case of bilateral pneumothoraces, two cases of severe subcutaneous emphysema, and three cases of postoperative bleeding. Review of the long-term complications in this series demonstrates the benefits of the silicone rubber polymer tube. Since its routine use, problems with stomal granulation have almost disappeared. There have been no problems in extubating the very young babies. Our operative technique and intensive care management of these babies will be emphasized as the keys to the improved outcome.
Authors:
J J Tepas; J H Heroy; D W Shermeta; J A Haller
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Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  Surgery     Volume:  89     ISSN:  0039-6060     ISO Abbreviation:  Surgery     Publication Date:  1981 May 
Date Detail:
Created Date:  1981-06-23     Completed Date:  1981-06-23     Revised Date:  2004-11-17    
Medline Journal Info:
Nlm Unique ID:  0417347     Medline TA:  Surgery     Country:  UNITED STATES    
Other Details:
Languages:  eng     Pagination:  635-9     Citation Subset:  AIM; IM    
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MeSH Terms
Descriptor/Qualifier:
Airway Obstruction / congenital
Humans
Hyaline Membrane Disease / surgery
Infant, Newborn
Infant, Newborn, Diseases / surgery*
Tracheotomy* / instrumentation

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


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