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[Tracheotomy in children. Indications, major surgical principles, importance of nursing]
1Service d'otorhinolaryngologie de chirurgie cervico-faciale et de phoniatrie, hôpital Edouard-Herriot, Lyon, France.
Insights
Pediatric tracheotomy is indicated for upper airway obstructions, often due to post-intubation stenosis, and for long-term mechanical ventilation. Proper care minimizes complications, enabling home recovery for children needing prolonged tracheotomy.
Area of Science:
- Pediatric surgery
- Respiratory medicine
- Critical care
Context:
- Tracheotomy in children is primarily for upper airway obstructions and prolonged mechanical ventilation.
- Post-intubation stenosis is a leading cause of pediatric airway obstruction requiring tracheotomy.
- Managing children with tracheotomy necessitates specialized care and parental education for safe home management.
Purpose:
- To outline the primary indications for pediatric tracheotomy.
- To discuss potential complications, emphasizing accidental decannulation.
- To highlight strategies for successful home care for children with long-term tracheotomy.
Summary:
- Pediatric tracheotomy is indicated for upper respiratory tract obstructions (e.g., post-intubation stenosis) and long-term mechanical ventilation.
- While generally safe with proper care, accidental decannulation is a significant concern.
- Parental education and adapted home environments are crucial for children requiring long-term tracheotomy.
Impact:
- Informing clinical practice regarding pediatric tracheotomy indications and management.
- Reducing tracheotomy-related complications through improved preventive measures during intubation.
- Facilitating the safe transition of tracheotomized children from hospital to home environments.
Abstract:
Tracheotomy in children has two main fields of indication: 1) obstructions of the upper respiratory tract, the main cause being today the post-intubation stenosis; 2) long term mechanical ventilation. When performed in good conditions, with adapted care, there are few complications, among them the accidental denaculation being the most worrying. When long-term tracheotomy is needed, parent-education, together with special equipment and adapted environment may allow the return of the tracheotomised child at home in secure conditions. Special attention with preventive measures during intubation is recommended in order to reduce the number of tracheotomies for post-intubation stenosis.