Perioperative and Long-Term Outcomes in Infants Undergoing a Tracheostomy from a Neonatal Intensive Care Unit.

Autor: Lambert EM; Division of Pediatric Otolaryngology, Derpartment of Surgery, Baylor College of Medicine, Texas Children's Hospital, Houston, Texas, U.S.A., Ramaswamy U; Division of Pediatric Otolaryngology, Derpartment of Surgery, Baylor College of Medicine, Texas Children's Hospital, Houston, Texas, U.S.A., Gowda SH; Division of Neonatology, Department of Pediatrics, Baylor College of Medicine, Texas Children's Hospital, Houston, Texas, U.S.A., Spielberg DR; Division of Pulmonary and Sleep Medicine, Department of Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, Illinois, U.S.A., Hagan JL; Division of Neonatology, Department of Pediatrics, Baylor College of Medicine, Texas Children's Hospital, Houston, Texas, U.S.A., Xiao E; Baylor College of Medicine, Houston, Texas, U.S.A., Liu S; Department of Anesthesiology, Stanford University School of Medicine, Palo Alto, California, U.S.A., Villafranco N; Division of Pulmonary Medicine, Department of Pediatrics, Baylor College of Medicine, Texas Children's Hospital, Houston, Texas, U.S.A., Raynor T; Division of Pediatric Otolaryngology, Derpartment of Surgery, Baylor College of Medicine, Texas Children's Hospital, Houston, Texas, U.S.A., Baijal RG; Department of Pediatric Anesthesiology, Perioperative, and Pain Medicine, Baylor College of Medicine, Texas Children's Hospital, Houston, Texas, U.S.A.
Jazyk: angličtina
Zdroj: The Laryngoscope [Laryngoscope] 2024 Apr; Vol. 134 (4), pp. 1945-1954. Date of Electronic Publication: 2023 Sep 28.
DOI: 10.1002/lary.31058
Abstrakt: Objective: The purpose of this study was to identify risk factors for perioperative complications and long-term morbidity in infants from the neonatal intensive care unit (NICU) presenting for a tracheostomy.
Methods: This single-center retrospective cohort study included infants in the NICU presenting for a tracheostomy from August 2011 to December 2019. Primary outcomes were categorized as either a perioperative complication or long-term morbidity. A severe perioperative complication was defined as having either (1) an intraoperative cardiopulmonary arrest, (2) an intraoperative death, (3) a postoperative cardiopulmonary arrest within 30 days of the procedure, or (4) a postoperative death within 30 days of the procedure. Long-term morbidities included (1) the need for gastrostomy tube placement within the tracheostomy hospitalization and (2) the need for diuretic therapy, pulmonary hypertensive therapy, oxygen, or mechanical ventilation at 12 and 24 months following the tracheostomy.
Results: One-hundred eighty-three children underwent a tracheostomy. The mean age at tracheostomy was 16.9 weeks while the mean post-conceptual age at tracheostomy was 49.7 weeks. The incidence of severe perioperative complications was 4.4% (n = 8) with the number of pulmonary hypertension medication classes preoperatively (OR: 3.64, 95% CI: (1.44-8.94), p = 0.005) as a significant risk factor. Approximately 81% of children additionally had a gastrostomy tube placed at the time of the tracheostomy, and 62% were ventilator-dependent 2 years following their tracheostomy.
Conclusion: Our study provides critical perioperative complications and long-term morbidity data to neonatologists, pediatricians, surgeons, anesthesiologists, and families in the expected course of infants from the NICU presenting for a tracheostomy.
Level of Evidence: 3 Laryngoscope, 134:1945-1954, 2024.
(© 2023 The American Laryngological, Rhinological and Otological Society, Inc.)
Databáze: MEDLINE
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