First Clinical Consensus and National Recommendations on Tracheostomized Children of the Brazilian Academy of Pediatric Otorhinolaryngology (ABOPe) and Brazilian Society of Pediatrics (SBP) ☆ ☆☆ Translated title: Primeiro Consenso Clínico e Recomendações Nacionais em Crianças Traqueostomizadas da Academia Brasileira de Otorrinolaringologia Pediátrica (ABOPe) e Sociedade Brasileira de Pediatria (SBP)

There is no author summary for this article yet. Authors can add summaries to their articles on ScienceOpen to make them more accessible to a non-specialist audience.

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.

Resumo

Introdução

A traqueostomia é um procedimento que pode ser realizado 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 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.

Related collections

Most cited references 18

Record: found
Abstract: found
Article: not found

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.

0 comments Cited 64 times – based on 0 reviews      Review now

Bookmark

Record: found
Abstract: found
Article: not found

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.

0 comments Cited 25 times – based on 0 reviews      Review now

Bookmark

Record: found
Abstract: found
Article: found

Is Open Access

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.

0 comments Cited 17 times – based on 0 reviews      Review now

Bookmark

All references

Author and article information

Contributors

Melissa A.G. Avelino

Journal

Journal ID (nlm-ta): Braz J Otorhinolaryngol

Journal ID (iso-abbrev): Braz J Otorhinolaryngol

Title: Brazilian Journal of Otorhinolaryngology

Publisher: Elsevier

ISSN (Print): 1808-8694

ISSN (Electronic): 1808-8686

Publication date PMC-release: 27 June 2017

Publication date Collection: Sep-Oct 2017

Publication date (Electronic): 27 June 2017

Volume: 83

Issue: 5

Pages: 498-506

Affiliations

[a ]Universidade Federal de São Paulo (UNIFESP), Escola Paulista de Medicina (EPM), São Paulo, SP, Brazil

[b ]Universidade Federal de Goiás (UFG), Goiânia, GO, Brazil

[c ]Pontifícia Universidade Católica de Goiás (PUC-GO), Goiânia, GO, Brazil

[d ]Universidade Federal de Goiás (UFG), Hospital das Clínicas, Unidade de Cabeça e Pescoço, Goiânia, GO, Brazil

[e ]Universidade Estadual de Campinas (UNICAMP), Faculdade de Ciências Médicas, Departamento de Oftalmo/Otorrinolaringologia, Campinas, SP, Brazil

[f ]Universidade São Paulo (USP), Faculdade de Medicina de Ribeirão Preto, Departamento de Oftalmologia, Otorrinolaringologia e Cirurgia de Cabeça e Pescoço, Ribeirão Preto, SP, Brazil

[g ]Universidade Federal de Ciências da Saúde de Porto Alegre (UFCSPA), Porto Alegre, RS, Brazil

[h ]Hospital da Criança Santo Antônio, Serviço de Otorrinolaringologia Pediátrica, Porto Alegre, RS, Brazil

[i ]Universidade Federal do Rio Grande do Sul (UFRGS), Programa de Pós-graduação em Saúde da Criança e do Adolescente, Porto Alegre, RS, Brazil

[j ]Hospital de Clínicas de Porto Alegre, Porto Alegre, RS, Brazil

[k ]Universidade São Paulo (USP), Hospital das Clínicas da Faculdade de Medicina de Ribeirão Preto, Ribeirão Preto, SP, Brazil

[l ]Universidade Federal de São Paulo (UNIFESP), Escola Paulista de Medicina (EPM), Departamento de Otorrinolaringologia e Cirurgia de Cabeça e Pescoço, São Paulo, SP, Brazil

[m ]Associação de Assistência a Criança Deficiente (AACD), Clínica de Otorrinolaringologia, São Paulo, SP, Brazil

[n ]Universidade Federal do Ceará (UFC), Fortaleza, CE, Brazil

[o ]Hospital Pequeno Príncipe, Curitiba, PR, Brazil

[p ]Serviço de Assistência Integral à Criança Traqueostomizada (SAIT), Belo Horizonte, MG, Brazil

[q ]Universidade José do Rosário Vellano (UNIFENAS), Curso de Medicina, Belo Horizonte, MG, Brazil

[r ]Universidade Federal de Minas Gerais (UFMG), Hospital das Clínicas (HC), Pneumologia Pediátrica, Belo Horizonte, MG, Brazil

[s ]Universidade Federal de Goiás (UFG), Unidade de Terapia Intensiva, Goiânia, GO, Brazil

[t ]Universidade Estadual de Campinas (UNICAMP), Faculdade de Ciências Médicas, Departamento de Pediatria, Campinas, SP, Brazil

[u ]Universidade de São Paulo (FMUSP), Faculdade de Medicina, São Paulo, SP, Brazil

[v ]International Society for Otitis Media (ISOM), São Paulo, SP, Brazil

[w ]Universidade São Paulo (USP), Faculdade de Medicina de Ribeirão Preto, Ribeirão Preto, SP, Brazil

Author notes

[* ]Corresponding author. melissa.avelino@ 123456uol.com.br

Article

Publisher Item ID: S1808-8694(17)30101-5

DOI: 10.1016/j.bjorl.2017.06.002

PMC ID: 9444758

PubMed ID: 28807655

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

License:

This is an open access article under the CC BY license (http://creativecommons.org/licenses/by/4.0/).

History

Date received : 31 May 2017

Date accepted : 6 June 2017

Comments

Comment on this article

scite_

Cited by 9

See all cited by