Lippert Dylan, Hoffman Matthew R, Dang Phat, McMurray J Scott, Heatley Diane, Kille Tony
University of Wisconsin School of Medicine and Public Health, Division of Otolaryngology-Head and Neck Surgery, 600 Highland Ave, K4/720 Clinical Science Center, Madison, WI 53792, United States.
Rush University Medical Center, Department of General Surgery, Chicago, IL, United States.
Int J Pediatr Otorhinolaryngol. 2014 Dec;78(12):2281-5. doi: 10.1016/j.ijporl.2014.10.034. Epub 2014 Nov 3.
To analyze the safety of a standardized pediatric tracheostomy care protocol in the immediate postoperative period and its impact on tracheostomy related complications.
Retrospective case series.
Pediatric patients undergoing tracheotomy from February 2010-February 2014.
In 2012, a standardized protocol was established regarding postoperative pediatric tracheostomy care. This protocol included securing newly placed tracheostomy tubes using a foam strap with hook and loop fastener rather than twill ties, placing a fresh drain sponge around the tracheostomy tube daily, and performing the first tracheostomy tube change on postoperative day 3 or 4. Outcome measures included rate of skin breakdown and presence of a mature stoma allowing for a safe first tracheostomy tube change. Two types of tracheotomy were performed based on patient age: standard pediatric tracheotomy and adult-style tracheotomy with a Bjork flap. Patients were analyzed separately based on age and the type of tracheotomy performed.
Thirty-seven patients in the pre-protocol group and 35 in the post-protocol group were analyzed. The rate of skin breakdown was significantly lower in the post-protocol group (standard: p=0.0048; Bjork flap: p=0.0003). In the post-protocol group, all tube changes were safely accomplished on postoperative day three or four, and the stomas were deemed to be adequately matured to do so in all cases.
A standardized postoperative pediatric tracheostomy care protocol resulted in decreased rates of skin breakdown and demonstrated that pediatric tracheostomy tubes can be safely changed as early as 3 days postoperatively.
分析标准化小儿气管切开术后护理方案在术后即刻的安全性及其对气管切开相关并发症的影响。
回顾性病例系列研究。
2010年2月至2014年2月接受气管切开术的儿科患者。
2012年制定了关于小儿气管切开术后护理的标准化方案。该方案包括使用带钩环扣的泡沫带固定新置入的气管切开管，而非斜纹布带；每天在气管切开管周围放置一块新的引流海绵；并在术后第3天或第4天进行首次气管切开管更换。观察指标包括皮肤破损率以及是否存在成熟的造口以便安全地进行首次气管切开管更换。根据患者年龄进行两种类型的气管切开术：标准小儿气管切开术和带比约克瓣的成人式气管切开术。根据年龄和所进行的气管切开术类型分别对患者进行分析。
分析了方案实施前组的37例患者和方案实施后组的35例患者。方案实施后组的皮肤破损率显著更低（标准术式：p = 0.0048；比约克瓣术式：p = 0.0003）。在方案实施后组中，所有的气管切开管更换均在术后第3天或第4天安全完成，并且在所有病例中造口均被认为已充分成熟，可以进行更换。
标准化的小儿气管切开术后护理方案降低了皮肤破损率，并表明小儿气管切开管最早可在术后3天安全更换。
