Division of Oncological ORL Surgery, Department of Otorhinolaryngology, Heidelberg University Hospital, Im Neuenheimer Feld 400, 69120, Heidelberg, Germany.
Department of Pediatrics I, University Children's Hospital Heidelberg, 69120, Heidelberg, Germany.
Eur Arch Otorhinolaryngol. 2020 Apr;277(4):1139-1147. doi: 10.1007/s00405-020-05827-w. Epub 2020 Feb 4.
The aim of this study was to determine whether there were differences in decannulation rates and time to decannulation in children depending on the indication for tracheostomy, age, and maturity at birth.
Retrospective chart review and prospective interview by questionnaire.
The medical records of 106 pediatric patients (age 0-18 years) tracheostomized between January 1 1999 and January 1 2019 were reviewed. Patients were divided into three different groups depending on the indication for tracheostomy: unsafe airway (37.7%), long-term respiratory dependence (50.9%), or bronchopulmonary toilet for aspirations (11.3%).
40 patients were successfully decannulated. The time-dependent decannulation rate after 2 and 5 years was 28.3% and 40.5% for patients with an unsafe airway, 42.4% and 66.8% for patients with long-term respiratory dependence, and 41.7% and 70.8% for patients needing bronchopulmonary toilet, respectively. After 2 and 5 years, patients aged 0-12 months at the time of tracheostomy were decannulated in 13.1% and 50.2% of cases, 1-5-year-olds in 35.3% and 48.2% of cases, 6-10-year-olds in 70% and 70% of cases, and 11-18-year-olds in 66.6% and 66.6% of cases, respectively. However, in a multivariate analysis, prematurity was found to be the only significant unfavorable variable (p = 0.013). Maturely born patients had an odds ratio of 3.87 (95% CI 1.32-11.33) for successful decannulation. This effect was present only in the first 5 years of life.
Factors indicating problems with decannulation are an unsafe airway, a young age at the time of tracheostomy, and prematurity at birth.
本研究旨在确定儿童的气管切开术适应证、年龄和出生时的成熟度是否会影响拔管率和拔管时间。
回顾性病历分析和前瞻性问卷调查访谈。
回顾了 1999 年 1 月 1 日至 2019 年 1 月 1 日期间接受气管切开术的 106 例儿科患者（0-18 岁）的病历。根据气管切开术的适应证，患者分为三组：不安全气道（37.7%）、长期呼吸依赖（50.9%）或支气管肺灌洗用于吸引（11.3%）。
40 例患者成功拔管。在 2 年和 5 年后，气管切开术时年龄为 0-12 个月的患者的拔管率分别为 13.1%和 50.2%，1-5 岁的患者为 35.3%和 48.2%，6-10 岁的患者为 70%和 70%，11-18 岁的患者为 66.6%和 66.6%。然而，多变量分析显示，早产是唯一显著的不利因素（p = 0.013）。成熟出生的患者成功拔管的优势比为 3.87（95%可信区间 1.32-11.33）。这种影响仅存在于生命的前 5 年。
提示拔管困难的因素包括不安全的气道、气管切开术时年龄较小和出生时早产。
