Sachdev Anil, Ghimiri Amrit, Gupta Neeraj, Gupta Dhiren
Division of Pediatric Pulmonology, Department of Pediatrics, Institute of Child Health, Sir Ganga Ram Hospital, Rajinder Nagar, New Delhi, 110060, India.
Division of Pediatric Emergency, Critical Care and Pulmonology, Department of Pediatrics, Institute of Child Health, Sir Ganga Ram Hospital, Rajinder Nagar, New Delhi, 110060, India.
Pediatr Surg Int. 2017 Nov;33(11):1195-1200. doi: 10.1007/s00383-017-4152-x. Epub 2017 Sep 6.
This study was aimed to evaluate the utility and benefits of flexible fiberoptic bronchoscopy (FFB) prior to tracheostomy decannulation.
Besides demographic data, initial cause of tracheostomy, primary diagnosis, pre-tracheostomy and pre-decannulation bronchoscopic findings and duration of tracheostomy were collected from medical charts. The type of active intervention following bronchoscopy and outcome after decannulation were recorded. Departmental decannulation policy and procedure were used in all patients.
Forty-nine tracheostomized patients who underwent decannulation attempt were included. The median age of the children at the time of decannulation was 3 years (range 4 months-16 years). The median duration of tracheostomy was 8 months (range 1-86 months). Prolonged mechanical ventilation was the commonest indication for tracheostomy. There were 45 abnormal findings on FFB in 36 patients. Airway granulation was the commonest abnormality (23/45, 51%). Successful decannulation without any intervention was possible in 23 (46.9%) cases. 12 of these had normal bronchoscopy. Fifteen (30.6%) patients required surgical interventions before attempting decannulation. In five patients decannulation failed, while in six children decannulation was not attempted after FFB.
Pre-decannulation flexible fiberoptic bronchoscopy in children with tracheostomy helps in identifying the possible causes of decannulation failure and helps in deciding the appropriate intervention.
本研究旨在评估在气管造口脱管前进行可弯曲纤维支气管镜检查（FFB）的实用性和益处。
从病历中收集除人口统计学数据外的气管造口初始原因、初步诊断、气管造口术前和脱管前支气管镜检查结果以及气管造口持续时间。记录支气管镜检查后的积极干预类型和脱管后的结果。所有患者均采用科室脱管政策和程序。
纳入49例尝试脱管的气管造口患者。脱管时儿童的中位年龄为3岁（范围4个月至16岁）。气管造口的中位持续时间为8个月（范围1至86个月）。长时间机械通气是气管造口最常见的指征。36例患者的FFB检查有45项异常发现。气道肉芽是最常见的异常（23/45，51%）。23例（46.9%）患者无需任何干预即可成功脱管。其中12例支气管镜检查正常。15例（30.6%）患者在尝试脱管前需要手术干预。5例患者脱管失败，6例儿童在FFB检查后未尝试脱管。
气管造口儿童脱管前的可弯曲纤维支气管镜检查有助于识别脱管失败的可能原因，并有助于决定适当的干预措施。
