Cottrill Elizabeth, Lioy Janet, Elshenawy Summer, Rosenzweig Jaclyn, Hopkins Edward, Chuo John, Sobol Steven, DeMauro Sara
Otorhinolaryngology, University of Pennsylvania Health System, Philadelphia, PA, United States.
Neonatology, The Children's Hospital of Philadelphia, Philadelphia, PA, United States.
Int J Pediatr Otorhinolaryngol. 2015 Jan;79(1):15-7. doi: 10.1016/j.ijporl.2014.10.005. Epub 2014 Oct 19.
This study aims to describe respiratory support requirements at the time of hospital discharge for infants who undergo tracheostomy, and to determine whether certain indications for tracheostomy are significantly associated with ventilator or oxygen dependence at the time of discharge.
Retrospective chart review identified 150 patients who underwent tracheostomy before 1 year of age at a single center from 2007 to 2012 and were discharged alive. Patients were divided into groups based on primary indication for tracheostomy: chronic lung disease (CLD); cardiac; airway anomalies (e.g., tracheomalacia, subglottic stenosis); anatomic anomalies of head, neck and chest; neuro/muscular; mixed group (>1 primary indication). Chi-squared tests were used to compare respiratory support requirements at time of discharge, as well as need for supplemental oxygen.
Of the 150 patients included in the study, three were discharged on room air alone. Of those 147 who did require some form of support at discharge, significant differences were found between groups when comparing CPAP to ventilator support. For example, of the patients with CLD, 82% were discharged on ventilator support whereas of those with a primary airway indication nearly 54% were discharged on CPAP. Significant differences were also found among groups when comparing patients discharged on room air vs. supplemental oxygen. Patients with CLD were more likely to be discharged on supplemental oxygen (p=0.001) whereas of the patients with anatomic indication 77% required no supplemental oxygen at the time of discharge.
Respiratory support needs at the time of discharge for neonates who underwent tracheostomy varied significantly depending on the initial indication for tracheostomy. Information about respiratory requirements of infants who undergo tracheostomy can help clinicians counsel families and anticipate post-discharge needs.
本研究旨在描述接受气管造口术的婴儿出院时的呼吸支持需求，并确定气管造口术的某些指征是否与出院时的呼吸机依赖或氧依赖显著相关。
通过回顾性病历审查，确定了2007年至2012年在单一中心1岁前接受气管造口术且存活出院的150例患者。根据气管造口术的主要指征将患者分为几组：慢性肺病（CLD）；心脏疾病；气道异常（如气管软化、声门下狭窄）；头、颈和胸部的解剖异常；神经/肌肉疾病；混合组（>1个主要指征）。采用卡方检验比较出院时的呼吸支持需求以及补充氧气的需求。
在纳入研究的150例患者中，3例仅在室内空气中出院。在出院时确实需要某种形式支持的147例患者中，比较持续气道正压通气（CPAP）与呼吸机支持时，各组之间存在显著差异。例如，CLD患者中，82%出院时依赖呼吸机支持，而主要气道指征患者中近54%出院时依赖CPAP。比较在室内空气与补充氧气情况下出院的患者时，各组之间也存在显著差异。CLD患者更有可能在补充氧气的情况下出院（p=0.001），而解剖学指征患者中77%出院时不需要补充氧气。
接受气管造口术的新生儿出院时的呼吸支持需求因气管造口术的初始指征不同而有显著差异。有关接受气管造口术婴儿呼吸需求的信息可帮助临床医生为家庭提供咨询并预测出院后的需求。
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