Hospital Josefina Martínez, Santiago, Chile; Carrera de Kinesiología, Facultad de Ciencias de la Salud, Universidad San Sebastián, Sede Santiago, Chile; and Blanquerna Universitat Ramon Llull, Facultat de Ciencies de la Salut, Programa de Doctorado Salud, Bienestar y Bioética, Barcelona, Catalunya, Spain.
Programa Nacional de Asistencia Ventilatoria, Ministerio de Salud de Chile, Santiago, Chile; and Carrera de Kinesiología, Facultad de Ciencias de la Salud, Universidad San Sebastián, Sede Santiago, Chile.
Respir Care. 2023 Feb;68(2):173-179. doi: 10.4187/respcare.09673. Epub 2022 Dec 6.
Tracheostomy has many benefits for pediatric patients in the ICU, but it is also associated with complications. Accidental decannulation (AD) is a frequent complication and cause of mortality in this population. Our study aimed to determine the factors associated with AD in tracheostomized pediatric subjects.
This was a case-control study with 1:2 allocation ratio. Participants were tracheostomized children hospitalized in a prolonged mechanical ventilation hospital between 2013-2018. Each child who experienced decannulation during the study period was included as a case at the time of the event. Controls were obtained from the same population and were defined as subjects without an AD event during the same period.
One hundred forty patients were hospitalized at Josefina Martinez Hospital at the time, of whom 41 were selected as cases and 82 as controls. Median (interquartile range) age was 20 (12-36) months, being 60% male. The median time from tracheostomy placement to AD event was 364 (167-731) d. Eighty-four percent of subjects were mechanically ventilated. AD mainly occurred by self-decannulation (53.7%). The risk of AD was higher in children who reached the midline in a sitting position (odds ratio 9.5 [95% CI 1.59-53.90]), inner diameter (ID) tracheostomy tube size ≤ 4.0 mm (odds ratio 5.18 [95% CI 1.41-19.06]), and who had been hospitalized in hospital rooms with a low ratio of nursing staff for each subject (1 nurse to 4 subjects) (odds ratio 4.48 [95% CI 1.19-16.80]).
Factors associated with a higher risk of AD in tracheostomized children included the ability to reach the midline in a sitting position, the use of a smaller tracheostomy tube (≤ 4.0 mm ID), and lower supervision from staff.
气管切开术对 ICU 中的儿科患者有许多益处，但也与并发症有关。意外拔管（AD）是该人群中频繁发生的并发症和死亡原因。我们的研究旨在确定与气管切开的儿科患者 AD 相关的因素。
这是一项病例对照研究，分配比例为 1:2。参与者为 2013-2018 年在长时间机械通气医院住院的气管切开患儿。研究期间经历拔管的每个患儿均在事件发生时作为病例纳入。对照来自同一人群，定义为同期无 AD 事件的受试者。
Josefina Martinez 医院当时有 140 名患儿住院，其中 41 名患儿被选为病例，82 名患儿被选为对照。中位（四分位距）年龄为 20（12-36）个月，其中 60%为男性。从气管切开至 AD 事件的中位时间为 364（167-731）天。84%的患儿接受机械通气。AD 主要通过自行拔管（53.7%）发生。在能够坐直达到中线的患儿（比值比 9.5 [95%CI 1.59-53.90]）、内径（ID）气管切开管尺寸≤4.0mm（比值比 5.18 [95%CI 1.41-19.06]）和接受住院治疗的患儿中，AD 的风险更高病房内护士与每个患儿的比例较低（1 名护士对 4 名患儿）（比值比 4.48 [95%CI 1.19-16.80]）。
与气管切开的儿科患者 AD 风险增加相关的因素包括能够坐直达到中线、使用较小的气管切开管（≤4.0mm ID）和工作人员的监督较少。
