Grønhøj Christian, Charabi Birgitte, Buchwald Christian von, Hjuler Thomas
a Department of Otorhinolaryngology, Head and Neck Surgery and Audiology , Rigshospitalet, University of Copenhagen , Copenhagen , Denmark.
Acta Otolaryngol. 2017 Aug;137(8):868-871. doi: 10.1080/00016489.2017.1295469. Epub 2017 Mar 24.
Although pediatric tracheotomy is potentially life-saving, the procedure is associated with high risk of complications, and indications have changed the last decade. We report indications, complications, and lower airway infections (LAIs) to pediatric tracheotomy performed at a tertiary referral center.
We identified all children (<18 years) who underwent tracheotomy at our institution during 2008-2015. A review of hospital records was performed to extract data on indication of the procedure, complications, and information on pre- and postoperative LAI.
At a median age of 8 years (range: 4 months to 17 years), a total of 69 tracheotomies were performed. Neuromuscular disease (n = 21) was the most common cause for tracheotomy. The postoperative complication rate was 22%; early complications (<30 days) occurred in four patients, and nine patients encountered late complications such as wound granulation and tracheocutaneous fistula. Children without LAI prior to tracheotomy were at increased risk of LAI from the initial 30-days following surgery (OR: 2.91, 95% CI: 1.17-7.21; p = .02). Fifty-three percent (10/19) of all LAIs following tracheotomy were caused by Staphylococcus aureus (p < .01).
Pediatric tracheotomy was associated with considerable rates of minor early and late complications and high risk of short-term LAI. The main cause leading to tracheotomy was neuromuscular disease.
尽管小儿气管切开术可能挽救生命，但该手术并发症风险高，且在过去十年中手术指征已发生变化。我们报告了在一家三级转诊中心进行的小儿气管切开术的指征、并发症及下呼吸道感染（LAIs）情况。
我们确定了2008年至2015年期间在我们机构接受气管切开术的所有儿童（<18岁）。对医院记录进行回顾，以提取有关手术指征、并发症以及术前和术后LAI的信息。
中位年龄为8岁（范围：4个月至17岁），共进行了69例气管切开术。神经肌肉疾病（n = 21）是气管切开术最常见的原因。术后并发症发生率为22%；4例患者发生早期并发症（<30天），9例患者出现晚期并发症，如伤口肉芽组织和气管皮肤瘘。气管切开术前无LAI的儿童在术后最初30天内发生LAI的风险增加（OR：2.91，95%CI：1.17 - 7.21；p = 0.02）。气管切开术后所有LAIs中有53%（10/19）由金黄色葡萄球菌引起（p < 0.01）。
小儿气管切开术伴有相当比例的轻微早期和晚期并发症以及短期LAI的高风险。导致气管切开术的主要原因是神经肌肉疾病。
