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Pediatric tracheostomy

Anuja Bandyopadhyay, A Ioana Cristea, Stephanie D Davis, Veda L Ackerman, James E Slaven, Hasnaa E Jalou, Deborah C Givan, Ameet Daftary
RATIONALE: There is a lack of evidence regarding factors associated with failure of tracheostomy decannulation. OBJECTIVES: We aimed to identify characteristics of pediatric patients who fail a tracheostomy decannulation challenge Methods: A retrospective review was performed on all patients who had a decannulation challenge at a tertiary care center from June 2006 to October 2013. Tracheostomy decannulation failure was defined as reinsertion of the tracheostomy tube within 6 months of the challenge...
October 21, 2016: Annals of the American Thoracic Society
Mark Wigginton, Laura Lehrian
We compare airway management and lung isolation methods in two pediatric cases of congenital central hypoventilation syndrome undergoing bilateral throacoscopic phrenic-nerve-stimulator surgery. One child received lung isolation using a 7Fr bronchial blocker in conjunction with a 6.0 cuffed endotracheal tube; and the second received a technique of endobronchial intubation using a 3.5 microcuffed tube via the tracheostomy stoma in conjunction with 5.0 cuffed endotracheal intubation; a technique previously undescribed in pediatric patients...
October 20, 2016: Paediatric Anaesthesia
Molly Kraus, Michelle LeRiger
No abstract text is available yet for this article.
October 12, 2016: Canadian Journal of Anaesthesia, Journal Canadien D'anesthésie
Jennifer F Ha, Waseem Ostwani, Glenn Green
INTRODUCTION: With the advent of improved neonatal and pediatric intensive care management, tracheostomy is increasingly performed in children requiring prolonged ventilation. Even though tracheostomy is generally a safe procedure, there remains mortality and morbidity associated with it. OBJECTIVE: We report a rare complication of a tracheostomy tube resulting in extensive erosion and posterior tracheal false pouch secondary to a large tracheostomy tube and high positive end expiratory pressure in a 12-month-old infant...
November 2016: International Journal of Pediatric Otorhinolaryngology
Benjamin Nicholson, Harinder Dhindsa, Louis Seay
BACKGROUND: Blunt injuries to the cervical trachea remain rare but present unique and challenging clinical scenarios for prehospital providers. These injuries depend on prehospital providers either definitively securing the injured airway or bridging the patient to a treatment facility that can mobilize the necessary resources. CASE SUMMARY: The case presented here involves a clothesline injury to a pediatric patient that resulted in complete tracheal transection and partial esophageal transection...
October 4, 2016: Prehospital Emergency Care
Yolanda Peña-López, Montserrat Pujol, Magda Campins, Alicia González-Antelo, Jose Ángel Rodrigo, Joan Balcells, Jordi Rello
OBJECTIVE: To reduce ventilator-associated infections (VARI) and improve outcomes for children. METHODS: This prospective interventional cohort study was conducted in a paediatric intensive care unit (PICU) over three periods: pre-intervention, early post-intervention, and late post-intervention. These children were on mechanical ventilation (MV) for ≥48h. RESULTS: Overall, 312 children (11.9% of whom underwent tracheostomy) and 6187 ventilator-days were assessed...
September 26, 2016: International Journal of Infectious Diseases: IJID
Maryam Oskoui, Pamela Ng, Stephen Liben, David Zielinski
BACKGROUND: Increasing numbers of families are requesting active supportive management for their child with spinal muscular atrophy type 1 (SMA1), leading to longer survival and greater prevalence of affected children. Strong opinions exist among physicians for and against the provision of care measures prolonging life. OBJECTIVE: To describe current practice in the care of SMA1 in Canada, and explore the factors underlying inter-physician variability. METHODS: A cross-sectional survey of Canadian hospital-based pediatric neurologists and pediatric respirologists was performed in 2015...
September 29, 2016: Pediatric Pulmonology
Ian Yuan, Benjamin B Bruins, Eleanor P Kiell, Luv R Javia, Jorge A Galvez
Awake tracheostomy is indicated for acute upper airway obstruction, when other methods of securing the airway, such as intubation and cricothyrotomy, have failed or are inappropriate. This option is rarely considered in pediatrics because of the concerns of patient cooperation and safety and has not been described in the literature. We describe the anesthetic management of an awake tracheostomy performed on a 7-year-old girl, with a large supraglottic mass obstructing the laryngeal introitus.
September 23, 2016: A & A Case Reports
David F Smith, Ting Sa, Matthew Fenchel, Aliza P Cohen, Christine Heubi, Sally R Shott, Christine G Gourin, Stacey L Ishman
OBJECTIVES/HYPOTHESIS: We sought to characterize changes in the patterns of inpatient surgical sleep care over time and ascertain if these changes were consistent with previously reported trends in adult surgical sleep care. STUDY DESIGN: Repeated cross-sectional study. METHODS: Discharge data from the U.S. Nationwide Inpatient Sample for 125,691 nasal, palatal, or hypopharyngeal procedures in children for sleep-disordered breathing or obstructive sleep apnea (OSA) from 1993 to 2010 were analyzed using cross-tabulations and multivariate regression modeling...
September 19, 2016: Laryngoscope
Norihiko Tsuboi, Kentaro Ide, Nao Nishimura, Satoshi Nakagawa, Noriko Morimoto
OBJECTIVES: The objective of this study was to investigate if there were any differences in survival and long-term outcomes between pediatric patients with and without neurological impairment who underwent tracheostomy. METHODS: A retrospective chart review of pediatric patients (age 0-15 years) who underwent tracheostomy between March 2002 and December 2013 was conducted. Patients were categorized into two groups: those who were neurologically impaired (NI) (pediatric cerebral performance category, 3-6) and those who were not neurologically impaired (NN) (pediatric cerebral performance category, 1-2)...
October 2016: International Journal of Pediatric Otorhinolaryngology
Cláudia Schweiger, Denise Manica, Carolina Fischer Becker, Larissa Santos Perez Abreu, Michelle Manzini, Leo Sekine, Gabriel Kuhl
INTRODUCTION: Children may require tracheostomy due to many different health conditions. Over the last 40 years, indications of tracheostomy have endorsed substantial modifications. OBJECTIVE: To evaluate pediatric patients warranted tracheostomy at our Hospital, in regard to their indications, associated comorbidities, complications and decannulation rates. METHODS: Retrospective study concerning patients under 18 years of age undergoing tracheostomy in a tertiary health care center, from January 2006 to November 2015...
August 24, 2016: Brazilian Journal of Otorhinolaryngology
Laura J Wozniak, Bita V Naini, Michelle J Hickey, Sarathi Bhattacharyya, Elaine F Reed, Ronald W Busuttil, Douglas G Farmer, Jorge H Vargas, Robert S Venick, Sue V McDiarmid
Acute AMR is well reported following ABO-incompatible LTx. However, it remains uncommon in ABO-compatible LTx. It typically presents with graft dysfunction ≤2 weeks post-LTx and is often associated with graft loss. We report the clinical presentation, treatment regimen, and outcome of six pediatric LTx recipients diagnosed with early acute AMR based on (i) clinical signs of graft dysfunction, (ii) histopathology indicative of acute injury ± C4d staining, and (iii) presence of HLA DSA. All patients developed elevated ALT and GGT ≤ 45 days post-LTx...
September 5, 2016: Pediatric Transplantation
Wallace B Wee, Scott Tavernini, Andrew R Martin, Israel Amirav, Carina Majaesic, Warren H Finlay
BACKGROUND: Pediatric tracheostomies are not uncommon and aerosols allow for targeted lung therapy. However, there is little literature that quantifies aerosol delivery through tracheostomies. Nebulizers are commonly used in delivering tobramycin, but there are drawbacks, for example, time burden. Dry powder inhalers (DPIs) can deliver higher payloads in less time. However, no data exist assessing DPIs with tracheostomies. OBJECTIVE: The study's aim was to quantify the amount of aerosolized tobramycin delivered to the lungs of in vitro tracheostomized spontaneously breathing pediatric models with the TOBI(®) Podhaler™ (Podhaler) and the PARI LC Plus(®) (LC Plus)...
August 26, 2016: Journal of Aerosol Medicine and Pulmonary Drug Delivery
Jennifer C DeMichele, Nikhil Vajaria, Hongyue Wang, Dawn M Sweeney, Karen S Powers, Jill M Cholette
STUDY OBJECTIVE: To determine the incidence of postoperative airway complications in infants <5kg in weight undergoing cardiac surgery intubated with Microcuff (Kimberley-Clark, Roswell, GA) endotracheal tubes (ETTs). DESIGN: Retrospective review of infants weighing <5.0 kg with congenital heart disease (CHD) presenting for cardiac surgery. SETTING: Single-center, tertiary pediatric cardiac critical care unit at a university hospital...
September 2016: Journal of Clinical Anesthesia
Sarah A Sobotka, Lindsey P Hird-McCorry, Denise M Goodman
BACKGROUND AND OBJECTIVES: The core mission of the Pulmonary Habilitation Program is to train and prepare caregivers for the care of a ventilated child in the home. It exists within a free-standing children's hospital. The program is supported by a multidisciplinary staff and serves ∼100 children. Through standardizing electronic documentation with process-specific tracking for the discharge process, the Pulmonary Habilitation Program team sought to identify intervention opportunities for more efficient and effective discharges...
September 2016: Hospital Pediatrics
Jessica R Levi, Michael C Topf, Nadia K Mostovych, Estelle Yoo, Patrick C Barth, Udayan K Shah
OBJECTIVES/HYPOTHESIS: To determine the rate of persistent tracheocutaneous fistula (TCF) in pediatric patients managed with stomal maturation at the time of the tracheostomy. STUDY DESIGN: Retrospective chart analysis of all cases of tracheostomy performed at a tertiary pediatric care center between 2001 and 2011. METHODS: The use of stomal maturation, number of decannulations, number of persistent TCFs, timing of TCF repair, and the overall mortality were assessed...
October 2016: Laryngoscope
Philip A Gaudreau, Hannah Greenlick, Tiffany Dong, Michelle Levy, Alyssa Hackett, Diego Preciado, George Zalzal, Brian K Reilly
Importance: Pediatric tracheostomy is commonly performed for upper airway obstruction and prolonged mechanical ventilation. Children undergoing tracheostomy typically have multiple chronic medical problems that place them at high risk for readmission and additional complications. Objective: To determine whether the institution of a postoperative protocol for parent education and wound care with a nurse trained in tracheostomy care decreases the rate of readmission and other complications...
October 1, 2016: JAMA Otolaryngology—Head & Neck Surgery
J-H Lee, C-H Koo, S-Y Lee, E-H Kim, I-K Song, H-S Kim, C-S Kim, J-T Kim
BACKGROUND: Few studies investigated the optimal timing for tracheostomy and its influence on the clinical outcomes in critically ill pediatric patients. This study evaluated the differences in clinical outcomes between early and late tracheostomy in pediatric intensive care unit (ICU) patients. METHODS: We assessed 111 pediatric patients. Patients who underwent a tracheostomy within 14 days of mechanical ventilation (MV) were assigned to the early tracheostomy group, whereas those who underwent tracheostomy after 14 days of MV were included in the late tracheostomy group...
October 2016: Acta Anaesthesiologica Scandinavica
Ozgul Gergin, Eelam A Adil, Kosuke Kawai, Karen Watters, Ethan Moritz, Reza Rahbar
IMPORTANCE: Recent reports have shown that the indications for pediatric tracheostomy have evolved over time. OBJECTIVE: To review the indications for pediatric tracheostomy over the last 30 years. DESIGN: Retrospective chart review. SETTING: Tertiary referral children's hospital. PARTICIPANTS: Patients who underwent tracheostomy. INTERVENTION: Surgical tracheostomy placement...
August 2016: International Journal of Pediatric Otorhinolaryngology
Jeffrey D Edwards, Amy J Houtrow, Adam R Lucas, Rachel L Miller, Thomas G Keens, Howard B Panitch, R Adams Dudley
OBJECTIVES: To characterize patients who received tracheostomies for airway compromise or were initiated on long-term ventilation for chronic respiratory failure in PICUs and to examine variation in the incidence of initiation, patient characteristics, and modalities across sites. DESIGN: Retrospective cross-sectional analysis. SETTINGS: Seventy-three North American PICUs that participated in the Virtual Pediatric Systems, LLC. PATIENTS: PICU patients admitted between 2009 and 2011...
August 2016: Pediatric Critical Care Medicine
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