Singh Abhishek, Zubair Arshad
All India Institute of Medical Sciences, New Delhi
National Hospital for Neurology and Neurosurgery, London WC1N 3BG
Tracheostomy is one of the oldest known surgical procedures. In 1718, Lorenz Heister coined the term "tracheostomy" to describe creating an opening in the neck and inserting a tube into the trachea. Medical and surgical advances have significantly improved this airway management procedure. Otolaryngologists and pediatric surgeons can perform tracheostomies on pediatric patients, and healthcare teams provide essential support for long-term stoma care, family education, supplies, and potentially mechanical ventilation. While perioperative and long-term care responsibilities may differ between hospitals, consensus guidelines have been established to ensure a standardized approach to caring for these patients across various disciplines. This activity reviews the general knowledge, operative considerations, wound care recommendations, and long-term strategies for pediatric tracheostomies by drawing on current literature. It will also address controversies and discussions surrounding decannulation protocols and highlight the role of the interprofessional team in caring for patients who undergo this procedure. The modern tracheostomy can be traced back to Armand Trousseau, who used the procedure to treat diphtheria-induced breathing difficulties in the mid-1800s. Chevalier Jackson later standardized the tracheostomy process in the early 1900s. While tracheostomy is deemed a life-saving procedure, older evidence indicates it poses a greater risk to children than adults. However, recent decades have witnessed a significant shift in indications for tracheostomy in pediatric patients due to improved survival rates among premature infants and those born with severe congenital anomalies. In the past, tracheostomy was typically employed for upper airway obstructions caused by infectious diseases, such as diphtheria. However, most pediatric tracheostomies performed in current clinical practice are indicated to support prolonged ventilation or address such problems as laryngotracheal stenosis, neurological disorders, trauma, or airway obstruction due to craniofacial abnormalities. While some medical professionals might still view pediatric tracheostomy as risky, new research indicates that its inherent risk may not be as significant as previously thought.
气管切开术是已知最古老的外科手术之一。1718年，洛伦兹·海斯特创造了“气管切开术”一词，用于描述在颈部开口并将管子插入气管的操作。医学和外科的进步显著改善了这一气道管理手术。耳鼻喉科医生和小儿外科医生可以为儿科患者实施气管切开术，医疗团队为长期造口护理、家庭教育、用品供应以及可能的机械通气提供重要支持。虽然不同医院围手术期和长期护理职责可能有所不同，但已制定了共识指南，以确保跨学科护理这些患者的方法标准化。本活动通过借鉴当前文献，回顾了小儿气管切开术的一般知识、手术注意事项、伤口护理建议和长期策略。它还将讨论围绕拔管方案的争议，并强调跨专业团队在护理接受该手术患者中的作用。现代气管切开术可追溯到阿尔芒·特鲁索，他在19世纪中叶用该手术治疗白喉引起的呼吸困难。后来，谢瓦利埃·杰克逊在20世纪初将气管切开术过程标准化。虽然气管切开术被认为是一种挽救生命的手术，但早期证据表明，它对儿童造成的风险比成人更大。然而，由于早产儿和患有严重先天性异常婴儿的存活率提高，近几十年来，儿科患者气管切开术的适应证发生了显著变化。过去，气管切开术通常用于治疗由传染病（如白喉）引起的上呼吸道阻塞。然而，当前临床实践中进行的大多数儿科气管切开术旨在支持长期通气或解决诸如喉气管狭窄、神经系统疾病、创伤或颅面异常引起的气道阻塞等问题。虽然一些医学专业人员可能仍认为儿科气管切开术有风险，但新研究表明，其固有风险可能没有以前认为的那么大。
