University of Pittsburgh School of Medicine, Pittsburgh, PA, USA.
University of Pittsburgh School of Medicine, Pittsburgh, PA, USA.
Am J Otolaryngol. 2024 Sep-Oct;45(5):104406. doi: 10.1016/j.amjoto.2024.104406. Epub 2024 Jul 22.
OBJECTIVE(S): To investigate the effectiveness of ciprofloxacin/dexamethasone in reducing granulation tissue post-tracheostomy in pediatric patients.
This cohort study examined pediatric patients with a tracheostomy at a single academic institution from 2016 to 2020. Exclusion criteria included: deceased within 1 year (n = 38), >16 years of age (n = 21), decannulated within 1 year (n = 15), lost to follow-up within 1 year (n = 6), and revision tracheostomy (n = 2). Logistic regression or Wilcoxon rank-sum (α = 0.05) were used to compare demographic and clinical characteristics between patients who did and did not receive ciprofloxacin/dexamethasone within 1 year of their tracheostomy.
In this cohort, (n = 126, median age 5.2 months, 54.0 % male), 62.7 % received ciprofloxacin/dexamethasone within 1 year, with 27.8 % taking the nebulized form. Granulation tissue occurred in 81.0 % of cases, predominantly peristomal (69.8 %) and suprastomal (34.9 %). Notable complications included accidental decannulation (13.6 %), suprastomal collapse (11.2 %), and bleeding (7.2 %). Although granulation tissue was more common in ciprofloxacin/dexamethasone users (92.4 %) versus non-users (61.7 %) (OR: 7.55, 95 % CI: 2.73-20.9, p < 0.001), patients exhibited less frequent granulation tissue events after initiation (z = 3.88, p < 0.001). No significant differences in antibiotic resistance (p = 1.0) or endocrinology complications (p = 0.1) were found between those with and without ciprofloxacin/dexamethasone.
We found a statistically significant reduction of granulation tissue incidence with ciprofloxacin/dexamethasone use and no significant differences in antibiotic resistance or endocrinology complications were noted. Future investigation is warranted to explore timing of ciprofloxacin/dexamethasone administration for granulation tissue and its role in managing and preventing tracheostomy complications.
研究环丙沙星/地塞米松在减少儿科患者气管切开术后肉芽组织形成中的作用。
本队列研究纳入了 2016 年至 2020 年在一家学术机构行气管切开术的儿科患者。排除标准包括：1 年内死亡（n=38）、年龄>16 岁（n=21）、1 年内拔管（n=15）、1 年内失访（n=6）和再次气管切开术（n=2）。采用逻辑回归或 Wilcoxon 秩和检验（α=0.05）比较气管切开后 1 年内接受和未接受环丙沙星/地塞米松治疗的患者的人口统计学和临床特征。
在本队列中（n=126，中位年龄 5.2 个月，54.0%为男性），62.7%的患者在 1 年内接受了环丙沙星/地塞米松治疗，其中 27.8%采用了雾化吸入的形式。81.0%的患者发生了肉芽组织，主要为气管切开部位周围（69.8%）和气管切开部位以上（34.9%）。显著并发症包括意外拔管（13.6%）、气管切开部位以上塌陷（11.2%）和出血（7.2%）。虽然接受环丙沙星/地塞米松治疗的患者（92.4%）比未接受治疗的患者（61.7%）更常见肉芽组织（OR：7.55，95%CI：2.73-20.9，p<0.001），但在开始治疗后，接受治疗的患者发生肉芽组织事件的频率较低（z=3.88，p<0.001）。接受和未接受环丙沙星/地塞米松治疗的患者之间，抗生素耐药性（p=1.0）或内分泌并发症（p=0.1）无显著差异。
我们发现环丙沙星/地塞米松的使用可显著降低肉芽组织的发生率，且未发现抗生素耐药性或内分泌并发症的显著差异。未来需要进一步研究环丙沙星/地塞米松的使用时机及其在管理和预防气管切开并发症中的作用。
