First Clinical Consensus and National Recommendations on Tracheostomized Children of the Brazilian Academy of Pediatric Otorhinolaryngology (ABOPe) and Brazilian Society of Pediatrics (SBP),

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Abstract

Abstract Introduction: Tracheostomy is a procedure that can be performed in any age group, including children under 1 year of age. Unfortunately health professionals in Brazil have great difficulty dealing with this condition due to the lack of standard care orientation. Objective: This clinical consensus by Academia Brasileira de Otorrinolaringologia Pediátrica (ABOPe) and Sociedade Brasileira de Pediatria (SBP) aims to generate national recommendations on the care concerning tracheostomized children. Methods: A group of experts experienced in pediatric tracheostomy (otorhinolaryngologists, intensive care pediatricians, endoscopists, and pediatric pulmonologists) were selected, taking into account the different regions of Brazil and following inclusion and exclusion criteria. Results: The results generated from this document were based on the agreement of the majority of participants regarding the indications, type of cannula, surgical techniques, care, and general guidelines and decannulation. Conclusion: These guidelines can be used as directives for a wide range of health professionals across the country that deal with tracheostomized children.

Translated abstract

Resumo Introdução: A traqueostomia é um procedimento que pode ser feito em qualquer faixa etária, inclusive em crianças abaixo de um ano. Infelizmente no Brasil existe uma enorme dificuldade dos profissionais de saúde em lidar com esta condição e uma falta de padronização dos cuidados. Objetivo: Este consenso clínico realizado pela Academia Brasileira de Otorrinolaringologia Pediátrica (ABOPe) e Sociedade Brasileira de Pediatria (SBP) tem como objetivo gerar recomendações nacionais sobre os cuidados e condutas diante das crianças traqueostomizadas. Método: Foram selecionados um grupo de especialistas com experiência em traqueostomia na infância (otorrinolaringologistas, pediatras intensivistas, endoscopistas, pneumopediatras) que tivessem comprovada atuação prática no assunto, e que também contemplassem as diversas regiões do Brasil, de acordo com os critérios de inclusão e exclusão. Resultados: Os resultados gerados neste documento foram obtidos a partir da concordância da maioria dos participantes em relação as indicações, tipo de cânula, técnicas cirúrgicas, cuidados e orientações gerais e decanulação. Conclusão: Estas diretrizes poderão servir como norteadoras para os mais diversos profissionais de saúde em todo país que lidam com as dificuldades das crianças traqueostomizadas.

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Clinical consensus statement: tracheostomy care.

Brian Nussenbaum, Débora Y. C. Brandt, Kathleen Deakins … (2012)

This clinical consensus statement (CCS) aims to improve care for pediatric and adult patients with a tracheostomy tube. Approaches to tracheostomy care are currently inconsistent among clinicians and between different institutions. The goal is to reduce variations in practice when managing patients with a tracheostomy to minimize complications. A formal literature search was conducted to identify evidence gaps and refine the scope of this consensus statement. The modified Delphi method was used to refine expert opinion and facilitate a consensus position. Panel members were asked to complete 2 scale-based surveys addressing different aspects of pediatric and adult tracheostomy care. Each survey was followed by a conference call during which results were presented and statements discussed. The panel achieved consensus on 77 statements; another 39 were dropped because of lack of consensus. Consensus was reached on statements that address initial tracheostomy tube change, management of emergencies and complications, prerequisites for decannulation, management of tube cuffs and communication devices, and specific patient and caregiver education needs. The consensus panel agreed on statements that address the continuum of care, from initial tube management to complications in children and adults with a tracheostomy. The panel also highlighted areas where consensus could not be reached and where more research is needed. This consensus statement should be used by physicians, nurses, and other stakeholders caring for patients with a tracheostomy.

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Tracheostomy--a 10-year experience from a UK pediatric surgical center.

Anita Corbett, P D Losty, Indu Mitra … (2007)

Tracheostomy in the pediatric population is associated with significant morbidity and mortality compared to adult practice. This study highlights evolving experience from a UK children's hospital. All children undergoing tracheostomy between 1995 and 2004 were identified. Indications, complications, and outcomes were evaluated. Complete case records were reviewed for 112 children (age range, newborn-18 years). Indications included congenital birth defects--craniofacial disorders, esophageal atresia, laryngeal cleft, cystic hygroma, vascular malformations. Acquired upper airway pathology (15.5%) and malacia (12.1%) were additional criteria. Tracheostomy was also required for long-term ventilation in patients with neuromuscular disorders (12.1%) or ventilator dependency (26.7 %). Fifty-eight (50%) tracheostomies were created in infants <1 year. One hundred and nine were elective procedures with only 7 (6%) for emergency airway management. Morbidity included wound problems (14, 14.4%), tube displacement or obstruction (14, 14.4%), tracheocutaneous fistula (6, 6.2%), and pneumothorax (4, 4.1%). There were no acute hemorrhagic complications. Two children died after accidental tube displacement/obstruction. Tracheostomy at this UK center is largely undertaken as an elective procedure. Children less than 1 year form an increasing patient group. Complications may be minimized by meticulous surgical technique and ensuring a comprehensive tracheostomy care program.

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Tracheostomy in childhood: review of the literature on complications and mortality over the last three decades ^☆ Translated title: Traqueostomia na infância: revisão da literatura sobre complicações e mortalidade nas últimas três décadas

Ana Paula Ligoski Dal’Astra, Ariane Quirino, Juliana Alves de Sousa Caixêta … (2016)

Introduction Tracheostomy is a procedure with unique characteristics when used on pediatric patients due to the greater technical difficulty and higher morbidity and mortality rates relative to the procedure in adults. In recent decades, there have been significant changes in the medical care available to children, particularly for those who need intensive care. Surgical conditions have also improved, and there has been an advent of new equipment and medications. These advances have brought changes to both tracheostomy indications and tracheostomy complications. Objective To perform a review of the articles published over the last three decades on the complications and mortality associated with tracheostomies in children. Methods Articles were selected from the Cochrane, Latin American and Caribbean Health Sciences Literature, SciELO, National Library of Medicine (Medline Plus), and PubMed online databases. The articles selected had been published between January 1985 and December 2014, and the data was compared using the Chi-square test. Results A total of 3797 articles were chosen, 47 of which were used as the basis for this review. When the three decades were evaluated as a whole, an increase in tracheostomies in male children under one year of age was found. The most common complications during the period analyzed in descending order of frequency were granuloma, infection, and obstruction of the cannula, accidental decannulation, and post-decannulation tracheocutaneous fistula. In the second and third decades of the review, granulomas represented the most common complication; in the first decade of the review, pneumothoraces were the most common. Mortality associated with tracheostomy ranged from 0% to 5.9%, while overall mortality ranged from 2.2% to 59%. In addition, the review included four studies on premature and/or very underweight infants who had undergone tracheostomies; the studies reported evidence of higher mortality in this age group to be largely associated with underlying diseases. Conclusion Improved surgical techniques and intensive care, the creation of new medications, and vaccines have all redefined the main complications and the mortality rates of tracheostomy in children. It is a safe procedure that increases chances of survival in those who require the prolonged use of mechanical ventilation. Introdução A traqueostomia é um procedimento com características exclusivas quando usada em pacientes pediátricos devido à maior dificuldade técnica e maiores taxas de morbidade e mortalidade em relação ao procedimento em adultos. Nas últimas décadas, houve mudanças significativas na assistência médica disponível para crianças, especialmente para aqueles que necessitam de cuidados intensivos. As condições cirúrgicas também melhoraram e houve um advento de novos equipamentos e medicamentos. Estes avanços trouxeram mudanças tanto para as indicações de traqueostomia como para as suas complicações. Objetivo Realizar uma revisão dos artigos publicados ao longo das últimas três décadas sobre as complicações e mortalidade em crianças associadas a traqueostomia. Método Os artigos foram selecionados das bases de dados online da Cochrane, Latin American and Caribbean Health Sciences Literature, SciELO, National Library of Medicine (Medline Plus) e PubMed. Os artigos selecionados foram publicados entre janeiro de 1985 e dezembro de 2014 e os dados foram comparados com uso de teste do Chi-quadrado. Resultados Foram selecionados 3.797 artigos, 47 dos quais foram usados como base para esta revisão. Quando as três décadas foram avaliadas como um todo, encontrou-se um aumento das traqueostomias em crianças do sexo masculino com menos de um ano de idade. As complicações mais comuns no período analisado, em ordem decrescente de frequência, foram granuloma, infecção, obstrução da cânula, decanulação acidental e fístula traqueocutânea pós-decanulação. Na segunda e terceira décadas de revisão, os granulomas representaram a complicação mais comum; na primeira década da revisão, pneumotórax foram as mais comuns. A mortalidade associada à traqueostomia variou de 0% a 5,9%, enquanto que a mortalidade global variou de 2,2% a 59%. Além disso, a revisão incluiu quatro estudos sobre lactentes prematuros e/ou nascidos com muito baixo peso que tinham sofrido traqueostomias; os estudos relataram evidências de que a maior mortalidade nessa faixa etária era em grande parte associada a doenças subjacentes. Conclusão A melhoria das técnicas cirúrgicas e de cuidados intensivos, a criação de novos medicamentos e vacinas redefiniram as principais complicações e as taxas de mortalidade da traqueostomia em crianças. É um procedimento seguro que aumenta as chances de sobrevida naqueles que requerem o uso prolongado de ventilação mecânica.

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Contributors

Melissa A.G. Avelino: Role: ND

Rebecca Maunsell: Role: ND

Fabiana Cardoso Pereira Valera: Role: ND

José Faibes Lubianca Neto: Role: ND

Cláudia Schweiger: Role: ND

Carolina Sponchiado Miura: Role: ND

Vitor Guo Chen: Role: ND

Dayse Manrique: Role: ND

Raquel Oliveira: Role: ND

Fabiano Gavazzoni: Role: ND

Isabela Furtado de Mendonça Picinin: Role: ND

Paulo Bittencourt: Role: ND

Paulo Camargos: Role: ND

Fernanda Peixoto: Role: ND

Marcelo Barciela Brandão: Role: ND

Tania Maria Sih: Role: ND

Wilma Terezinha Anselmo-Lima: Role: ND

Journal

Journal ID (publisher-id): bjorl

Title: Brazilian Journal of Otorhinolaryngology

Abbreviated Title: Braz. j. otorhinolaryngol.

Publisher: Associação Brasileira de Otorrinolaringologia e Cirurgia Cervicofacial (São Paulo, SP, Brazil )

ISSN (Print): 1808-8694

ISSN (Electronic): 1808-8686

Publication date (Print and electronic): October 2017

Volume: 83

Issue: 5

Pages: 498-506

Affiliations

[23] Ribeirão Preto orgnameUniversidade de São Paulo orgdiv1Faculdade de Medicina de Ribeirão Preto Brazil

[17] Belo Horizonte Minas Gerais orgnameUniversidade José do Rosário Vellano orgdiv1Curso de Medicina Brazil

[3] Goiânia Goiás orgnamePontifícia Universidade Católica de Goiás Brazil

[9] Porto Alegre Rio Grande do Sul orgnameUniversidade Federal do Rio Grande do Sul orgdiv1Programa de Pós-graduação em Saúde da Criança e do Adolescente Brazil

[11] Ribeirão Preto orgnameUniversidade de São Paulo orgdiv1Faculdade de Medicina de Ribeirão Preto orgdiv2Hospital das Clínicas Brazil

[5] Campinas São Paulo orgnameUniversidade Estadual de Campinas orgdiv1Faculdade de Ciências Médicas orgdiv2Departamento de Oftalmo/Otorrinolaringologia Brazil

[7] Porto Alegre Rio Grande do Sul orgnameUniversidade Federal de Ciências da Saúde de Porto Alegre Brazil

[19] Goiânia Goiás orgnameUniversidade Federal de Goiás orgdiv1Unidade de Terapia Intensiva Brazil

[18] Belo Horizonte Minas Gerais orgnameUniversidade Federal de Minas Gerais orgdiv1Hospital das Clínicas (HC) Brazil

[22] São Paulo SP orgnameInternational Society for Otitis Media Brazil

[4] Goiânia Goiás orgnameUniversidade Federal de Goiás orgdiv1Hospital das Clínicas orgdiv2Unidade de Cabeça e Pescoço Brazil

[14] Fortaleza Ceará orgnameUniversidade Federal do Ceará Brazil

[15] Curitiba PR orgnameHospital Pequeno Príncipe Brazil

[12] São Paulo orgnameUniversidade Federal de São Paulo orgdiv1Escola Paulista de Medicina (EPM) orgdiv2Departamento de Otorrinolaringologia e Cirurgia de Cabeça e Pescoço Brazil

[1] São Paulo orgnameUniversidade Federal de São Paulo orgdiv1Escola Paulista de Medicina (EPM) Brazil

[8] Porto Alegre Rio Grande do Sul orgnameHospital da Criança Santo Antônio orgdiv1Serviço de Otorrinolaringologia Pediátrica Brazil

[2] Goiânia Goiás orgnameUniversidade Federal de Goiás Brazil

[20] Campinas São Paulo orgnameUniversidade Estadual de Campinas orgdiv1Faculdade de Ciências Médicas orgdiv2Departamento de Pediatria Brazil

[6] Ribeirão Preto orgnameUniversidade de São Paulo orgdiv1Faculdade de Medicina de Ribeirão Preto orgdiv2Departamento de Oftalmologia, Otorrinolaringologia e Cirurgia de Cabeça e Pescoço Brazil

[16] Belo Horizonte MG orgnameServiço de Assistência Integral à Criança Traqueostomizada Brazil

[13] São Paulo SP orgnameAssociação de Assistência a Criança Deficiente orgdiv1Clínica de Otorrinolaringologia Brazil

[21] São Paulo São Paulo orgnameUniversidade de São Paulo orgdiv1Faculdade de Medicina Brazil

[10] Porto Alegre RS orgnameHospital de Clínicas de Porto Alegre Brazil

Article

Publisher ID: S1808-86942017000500498

DOI: 10.1016/j.bjorl.2017.06.002

SO-VID: af01d3ef-8335-4960-bada-fe857b457171

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This work is licensed under a Creative Commons Attribution 4.0 International License.

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Date accepted : 06 June 2017

Date received : 31 May 2017

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Figures: 0, Tables: 0, Equations: 0, References: 14, Pages: 9

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SciELO Brazil

Keywords: Criança,Diretrizes,Consenso,Tracheostomy,Child,Guidelines,Consensus,Traqueostomia

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Keywords: Criança, Diretrizes, Consenso, Tracheostomy, Child, Guidelines, Consensus, Traqueostomia

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Most cited references 18

Clinical consensus statement: tracheostomy care.

Tracheostomy--a 10-year experience from a UK pediatric surgical center.

Tracheostomy in childhood: review of the literature on complications and mortality over the last three decades ^☆ Translated title: Traqueostomia na infância: revisão da literatura sobre complicações e mortalidade nas últimas três décadas

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SciELO Brazil

Clinical consensus statement: tracheostomy care.

Tracheostomy--a 10-year experience from a UK pediatric surgical center.

Tracheostomy in childhood: review of the literature on complications and mortality over the last three decades ☆ Translated title: Traqueostomia na infância: revisão da literatura sobre complicações e mortalidade nas últimas três décadas

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Tracheostomy in childhood: review of the literature on complications and mortality over the last three decades ^☆ Translated title: Traqueostomia na infância: revisão da literatura sobre complicações e mortalidade nas últimas três décadas