Fuller Colin, Wineland Andre' M, Richter Gresham T
Department of Otolaryngology, Head and Neck Surgery, University of Arkansas for Medical Sciences, 1 Children's Way, Little Rock, AR 72202 USA.
Division of Pediatric Otolaryngology, Arkansas Children's Hospital, Little Rock, AR USA.
Curr Otorhinolaryngol Rep. 2021;9(2):188-199. doi: 10.1007/s40136-021-00340-y. Epub 2021 Apr 15.
Tracheostomy in a child demands critical pre-operative evaluation, deliberate family education, competent surgical technique, and multidisciplinary post-operative care. The goals of pediatric tracheostomy are to establish a safe airway, optimize ventilation, and expedite discharge. Herein we provide an update regarding timing, surgical technique, complications, and decannulation, focusing on a longitudinal approach to pediatric tracheostomy care.
Pediatric tracheostomy is performed in approximately 0.2% of inpatient stays among tertiary pediatric hospitals. Mortality in children with tracheostomies ranges from 10-20% due to significant comorbidities in this population. Tracheostomy-specific mortality and complications are now rare. Recent global initiatives have aimed to optimize decision-making, lower surgical costs, reduce the length of intensive care, and eliminate perioperative wound complications. The safest road to tracheostomy decannulation in children remains to be both patient and provider dependent.
Recent literature provides guidance on safe, uncomplicated, and long-term tracheostomy care in children. Further research is needed to help standardize decannulation protocols.
儿童气管切开术需要进行严格的术前评估、精心的家庭教育、熟练的手术技术以及多学科的术后护理。小儿气管切开术的目标是建立安全气道、优化通气并加快出院。在此，我们提供有关时机、手术技术、并发症和拔管方面的最新情况，重点关注小儿气管切开术护理的纵向方法。
在三级儿童医院中，约0.2%的住院患儿会接受气管切开术。由于该人群存在严重的合并症，气管切开患儿的死亡率在10%至20%之间。目前，气管切开术特有的死亡率和并发症已较为罕见。近期的全球倡议旨在优化决策、降低手术成本、缩短重症监护时间并消除围手术期伤口并发症。儿童气管切开术拔管的最安全途径仍取决于患者和医疗服务提供者。
近期文献为儿童安全、无并发症和长期的气管切开术护理提供了指导。需要进一步研究以帮助规范拔管方案。
