Young Ashley, Szymczak Alexander, Valika Taher, Ghadersohi Saied, Hazkani Inbal
Feinberg School of Medicine, Northwestern University Chicago Illinois USA.
Department of Otolaryngology-Head and Neck Surgery Feinberg School of Medicine, Northwestern University Chicago Illinois USA.
Laryngoscope Investig Otolaryngol. 2025 Aug 21;10(4):e70245. doi: 10.1002/lio2.70245. eCollection 2025 Aug.
Suprastomal collapse is an understudied sequela of pediatric tracheostomy that may hinder decannulation. This study aims to investigate the prevalence and associated risk factors of suprastomal collapse following pediatric tracheostomy.
A retrospective cohort study of children who underwent tracheostomy at a tertiary-care children's hospital between 1/2012 and 12/2022.
A total of 255 children underwent tracheostomy, with 146 (57.3%) developing suprastomal collapse 10.7 ± 12.6 months after the tracheostomy. Patients younger than 6 months at the time of tracheostomy were twice as likely to develop suprastomal collapse (OR = 2.07, = 0.0059). Direct laryngoscopy and bronchoscopy findings associated with increased odds of collapse included tracheobronchomalacia (OR = 1.72, = 0.029), subglottic stenosis (OR = 2.96, = 0.000028), and glottic or subglottic edema (OR = 2.4, = 0.0012). The presence of peristomal granulation tissue and the surgical removal of this tissue were not significantly associated with the development of suprastomal collapse. On log-rank analysis, the median time to develop collapse was significantly longer in patients who underwent granulation tissue removal compared to those who did not (8.2 vs. 4.8 months, = 0.003). Patients with suprastomal collapse were significantly more likely to require upper airway surgery (OR 2.1, 95% CI 1.16-3.83, = 0.0125) or laryngotracheal reconstruction (OR 3.4, 95% CI 1.41-9.64, = 0.006) than those without collapse.
Suprastomal collapse occurred in 60% of our cohort and was associated with the need for airway reconstruction. Contributing factors included age at tracheostomy, tracheobronchomalacia, subglottic stenosis, and glottic and subglottic edema. Despite concerns about weakening tracheal cartilage, granulation tissue removal was not associated with the development of collapse.
造口上塌陷是小儿气管切开术一种研究较少的后遗症，可能会阻碍拔管。本研究旨在调查小儿气管切开术后造口上塌陷的发生率及相关危险因素。
对2012年1月至2022年12月在一家三级儿童医院接受气管切开术的儿童进行回顾性队列研究。
共有255名儿童接受了气管切开术，其中146名（57.3%）在气管切开术后10.7±12.6个月出现造口上塌陷。气管切开术时年龄小于6个月的患者发生造口上塌陷的可能性是其他患者的两倍（OR=2.07，P=0.0059）。与塌陷几率增加相关的直接喉镜和支气管镜检查结果包括气管支气管软化（OR=1.72，P=0.029）、声门下狭窄（OR=2.96，P=0.000028）和声门或声门下水肿（OR=2.4，P=0.0012）。造口周围肉芽组织的存在以及该组织的手术切除与造口上塌陷的发生无显著相关性。对数秩分析显示，与未进行肉芽组织切除的患者相比，进行肉芽组织切除的患者发生塌陷的中位时间明显更长（8.2个月对4.8个月，P=0.003）。与未发生塌陷的患者相比，发生造口上塌陷的患者更有可能需要进行上气道手术（OR 2.1，95%CI 1.16-3.83，P=0.0125）或喉气管重建（OR 3.4，95%CI 1.41-9.64，P=0.006）。
我们队列中有60%的患者发生了造口上塌陷，且与气道重建的需求相关。相关因素包括气管切开术时的年龄、气管支气管软化、声门下狭窄以及声门和声门下水肿。尽管担心会削弱气管软骨，但肉芽组织切除与塌陷的发生无关。
4级。
