Laryngotracheal separation in pediatric patients: 13-year experience in a reference service.

Autor: Antunes LA; Hospital Pequeno Príncipe, Curitiba, PR, Brazil., Talini C; Hospital Pequeno Príncipe, Curitiba, PR, Brazil., Carvalho BCN; Hospital Pequeno Príncipe, Curitiba, PR, Brazil., Guerra JP; Hospital Pequeno Príncipe, Curitiba, PR, Brazil., Aristides EDS; Hospital Pequeno Príncipe, Curitiba, PR, Brazil., Oliveira DE; Hospital Pequeno Príncipe, Curitiba, PR, Brazil., Avilla SGA; Hospital Pequeno Príncipe, Curitiba, PR, Brazil.
Jazyk: English; Portuguese
Zdroj: Einstein (Sao Paulo, Brazil) [Einstein (Sao Paulo)] 2019 Jun 03; Vol. 17 (3), pp. eAO4467. Date of Electronic Publication: 2019 Jun 03.
DOI: 10.31744/einstein_journal/2019AO4467
Abstrakt: Objective: To evaluate clinical stability of neurologically impaired children and adolescents with recurrent pneumonia submitted to laryngotracheal separation.
Methods: Between October 2002 and June 2015, 92 neurologically impaired children from a reference service, with median age of 68.5 months were submitted to laryngotracheal separation. Data were evaluated and statistical analysis was made by Student's t test and Pearson's χ2 test (significance level adopted of 95%).
Results: Fifty-three children were male (57.6%). Forty-six children required admission to intensive care, and 42.4% needed mechanical ventilation. We observed that 90.2% of patients were exclusively fed by gastrostomy and 72.4% of the gastrostomies were performed before the tracheal surgery. Thirteen (14.1%) children had postoperative complications as follows: fistulae (5.4%), bleeding (4.3%), granuloma (2.2%) and stenosis (3.2%). A total of 24 patients had pneumonia in the postoperative period (26.1%), but there was a significant drop in occurrence of this condition after surgery (100% versus 26.1%; p<0.001). Twenty-three patients (25%) died. Postoperative complications were similar when comparing patients who died and those that presented good outcome (16.7% versus 13.2%; p=0.73).
Conclusion: When well-indicated, the laryngotracheal separation reduces the incidence of postoperative pulmonary infections, thus improving quality of life and reducing admissions to hospital. Laryngotracheal separation should be indicated as a primary procedure in patients with cerebral palsy and recurrent aspiration pneumonia.
Databáze: MEDLINE
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