Leelapatharaphan Nualwan, Tungkeeratichai Jumroon, Preutthipan Aroonwan
Department of Otolaryngology Head and Neck Surgery, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, 270 Rama VI Road, Ratchathewi, Bangkok, 10400, Thailand.
Division of Pediatric Pulmonology, Department of Pediatrics, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, 270 Rama VI Road, Ratchathewi, Bangkok, 10400, Thailand.
Int J Pediatr Otorhinolaryngol. 2025 Jun;193:112323. doi: 10.1016/j.ijporl.2025.112323. Epub 2025 Mar 24.
To describe the epidemiology, indications, complications, mortality and outcomes in pediatric tracheostomy over 10 years at Ramathibodi Hospital, Mahidol University, Bangkok, Thailand while identifying factors associated with unsuccessful decannulation.
A single-center case series was conducted on pediatric tracheostomies performed from January 2013 to June 2023.
121 tracheostomies were performed in Thai children at Ramathibodi Hospital. The median age at tracheostomy was 1.4 [IQR 0.3, 5.3] years. The two most common indications were upper airway obstruction (52 %) and prolonged intubation (34 %). Six patients (5.0 %) developed intraoperative complications, including cardiac arrest (1.7 %), hypoxia (1.7 %), esophageal injury (0.8 %), and death (0.8 %). The early postoperative complication was one case of pneumothorax (0.8 %). Late complications (68 %) included peristomal granuloma (28 %) and tracheitis (9 %), bleeding (8.2 %), distal tracheal granuloma (8.2 %), accidental decannulation (8.2 %), and local wound infection (6.4 %). The tracheostomy-related mortality rate was 3.6 % from tube occlusion due to secretion block (0.9 %), trachea-innominate artery fistula (0.9 %), accidental disconnection from a mechanical ventilator (0.9 %), and distal tracheal granuloma obstructing the trachea (0.9 %). The decannulation success rate was 21 %. Unsuccessful decannulation was associated with patients under 2 years old at the time of tracheostomy, as well as comorbidities such as gastroesophageal reflux disease and neurological disorder. These findings remained significant on multivariate analysis (adjusted hazard ratio 0.36 [95 % CI, 0.15, 0.90], P = 0.029 for age younger than 2 years, 0.27 [95 % CI, 0.10, 0.78], P = 0.015 for GERD and 0.15 [95 % CI, 0.05, 0.46], P = 0.001 for neurological comorbidities, respectively.
Patients in younger age groups or those with gastroesophageal reflux disease and neurological comorbidities were more difficult to decannulate. Further studies should focus on investigating the potential benefits of managing reflux symptoms in improving the decannulation rates for patients.
描述泰国曼谷玛希隆大学拉玛提波迪医院10年间小儿气管切开术的流行病学、适应证、并发症、死亡率及结局，同时确定与拔管失败相关的因素。
对2013年1月至2023年6月期间实施的小儿气管切开术进行单中心病例系列研究。
拉玛提波迪医院为泰国儿童实施了121例气管切开术。气管切开术时的中位年龄为1.4[四分位间距0.3，5.3]岁。最常见的两个适应证是上气道梗阻（52%）和长时间插管（34%）。6例患者（5.0%）发生术中并发症，包括心脏骤停（1.7%）、缺氧（1.7%）、食管损伤（0.8%）和死亡（0.8%）。术后早期并发症为1例气胸（0.8%）。晚期并发症（68%）包括造口周围肉芽肿（28%）、气管炎（9%）、出血（8.2%）、气管远端肉芽肿（8.2%）、意外脱管（8.2%）和局部伤口感染（6.4%）。气管切开术相关死亡率为3.6%，原因包括分泌物堵塞致导管阻塞（0.9%）、气管无名动脉瘘（0.9%）、机械通气意外脱开（0.9%）和气管远端肉芽肿阻塞气管（0.9%）。拔管成功率为21%。拔管失败与气管切开术时年龄小于两岁的患者以及胃食管反流病和神经疾病等合并症有关。多因素分析显示这些结果仍具有统计学意义（年龄小于2岁时调整后风险比0.36[95%置信区间，0.15，0.90]，P = 0.029；胃食管反流病为0.27[95%置信区间，0.10，0.78]，P = 0.015；神经合并症为0.15[95%置信区间，0.05，0.46]，P = 0.001）。
年龄较小的患者或患有胃食管反流病和神经合并症的患者更难拔管。进一步研究应聚焦于探讨控制反流症状对提高患者拔管率的潜在益处。
