Department of Otolaryngology - Head and Neck Surgery, University Hospitals Cleveland Medical Center/Case Western Reserve University, Cleveland, OH, USA.
Division of Otolaryngology, Children's Mercy Hospital-Kansas City, Kansas City, MO, USA.
Int J Pediatr Otorhinolaryngol. 2021 Jan;140:110540. doi: 10.1016/j.ijporl.2020.110540. Epub 2020 Dec 1.
Tracheostomy in children is often performed to alleviate airway obstruction (AO) or to facilitate long-term ventilator support due to respiratory failure of various etiologies, such as heart failure, and postoperative respiratory failure. Although many of these pathologies are common among trisomy 21 patients, tracheostomy rates among this population have not previously been reported. The aim of our study was to determine the incidence of trisomy 21 patients undergoing tracheostomy. Secondary objectives include decannulation rates and mortality associated with tracheostomy.
A retrospective cohort study was conducted on pediatric trisomy 21 patients undergoing tracheostomy between 2004 and 2013.
Twenty patients underwent tracheostomy at a median age of 7.1 months (interquartile range [IQR] = 3.5,21.3). The estimated incidence of tracheostomy in trisomy 21 patients among our tracheostomy population was 1.7% (20/1173) over 10 years. The most common indications were airway obstruction (AO) (55%), cardiac/pulmonary respiratory failure (CRF) (25%), or both (20%). Overall mortality was 30%, much lower among AO patients (9%) than CRF (40%) or both (60%), (P = 0.029). Nine patients (45%) were successfully decannulated, with median duration of cannulation of 2.2 years (IQR = 1.7,3).
This study suggests a rate of tracheostomy in the pediatric trisomy 21 population approximately 3 times that of the general pediatric population. Over half in this cohort underwent tracheostomy for isolated AO, while the general pediatric tracheostomy population demonstrates a much higher prevalence of prematurity-related CRF. Overall mortality rate and decannulation rate approximated that of the general pediatric tracheostomy population, although outcomes were significantly poorer among patients trisomy 21 patients undergoing tracheostomy for CRF.
在儿童中，气管切开术通常用于缓解气道阻塞（AO）或为各种病因（如心力衰竭和术后呼吸衰竭）的长期呼吸机支持提供便利。尽管这些病理在 21 三体综合征患者中很常见，但该人群的气管切开术率以前并未报道过。我们的研究目的是确定接受气管切开术的 21 三体综合征患者的发生率。次要目标包括与气管切开术相关的拔管率和死亡率。
对 2004 年至 2013 年间接受气管切开术的儿科 21 三体综合征患者进行回顾性队列研究。
20 名患者在中位数年龄为 7.1 个月（四分位距 [IQR] = 3.5,21.3）时接受了气管切开术。在我们的气管切开术患者中，10 年内 21 三体综合征患者的气管切开术发生率估计为 1.7%（20/1173）。最常见的适应症是气道阻塞（AO）（55%）、心脏/肺部呼吸衰竭（CRF）（25%）或两者兼有（20%）。总体死亡率为 30%，AO 患者（9%）明显低于 CRF（40%）或两者兼有（60%），（P = 0.029）。9 名患者（45%）成功拔管，中位置管时间为 2.2 年（IQR = 1.7,3）。
本研究表明，儿科 21 三体综合征患者的气管切开术率约为普通儿科人群的 3 倍。该队列中有一半以上的患者因单纯 AO 接受了气管切开术，而普通儿科气管切开术患者中，与早产儿相关的 CRF 发病率要高得多。尽管死亡率和拔管率与普通儿科气管切开术人群相近，但在因 CRF 接受气管切开术的 21 三体综合征患者中，预后明显较差。
