Caracterização da traqueostomia na população pediátrica para desenvolvimento de protocolo de seguimento clínico e decanulação
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Data
2023-06-07
Autores
Santana, Renato Battistel
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Universidade Estadual Paulista (Unesp)
Resumo
Introdução: A traqueostomia na população pediátrica é procedimento de alta morbimortalidade quando comparado à população adulta. Protocolos baseados em evidências devem ser estabelecidos para diminuir a morbimortalidade associada e aumentar a taxa de decanulação. Objetivo: Realizar caracterização da população pediátrica submetida à traqueostomia e a partir desses dados realizar protocolo de seguimento clínico e decanulação baseado em evidências da literatura. Método: Trata-se de estudo observacional e retrospectivo de 111 crianças menores de 18 anos de idade que foram submetidas à traqueostomia em hospital terciário por período de 9 anos. Levantou-se dados de prontuário médico a respeito de perfil epidemiológico, indicações e comorbidades mais prevalentes e principais desfechos, como, por exemplo, complicações, mortalidade e decanulação. Resultados: A idade mediana da população estudada foi de 2 anos e 2 meses. A principal indicação de traqueostomia foi a intubação por tempo prolongado (63%). A principal comorbidade relacionada foi a epilepsia (34%). Como principal complicação, a formação de rolha ocorreu em 10,8 % dos pacientes até os primeiros 7 dias após cirurgia e em 19,8% das crianças após o sétimo pós operatório. A mortalidade da amostra foi de 48,1% e a o índice de decanulação foi de 11,7%. Conclusão: A ausência de protocolos de seguimento hospitalar e ambulatorial, a alta mortalidade e presença de múltiplas comorbidades são fatores que podem ter contribuído para a baixa taxa de decanulação.
Introduction: Pediatric tracheostomy is a surgical procedure associated with high levels of morbidity and mortality when compared with the same procedure. In order to reduce these indexes and elevate decannulation index, it is necessary to implement evidence-based protocols. Objective: To characterize the pediatric population that was submitted to tracheostomy and compare this data to medical literacy in order to establish a follow-up and decannulation protocol. Methods: This is a retrospective and observational study with 111 children (from 1 day to 17 years old) who were submitted to tracheostomy in a tertiary Hospital over 9 years. Epidemiologic profile, surgery indications, comorbidities and the main outcomes, such as mortality and decannulation were the data collected from medical records. Results: The median age was 2 years and 2 months. The principal surgery indication was prolonged orotracheal intubation (63%). Epilepsy was present in 34% of the cases. The cannula obstruction was the main complication both for the first 7 days after surgery (10.8%) and after that period (19,8%). The sample mortality was 48.1% and the decannulation index was 11.7%. Conclusion: A follow-up protocol absence, high mortality and high rate of comorbidities were the factors that could influence the low decannulation success rate.
Introduction: Pediatric tracheostomy is a surgical procedure associated with high levels of morbidity and mortality when compared with the same procedure. In order to reduce these indexes and elevate decannulation index, it is necessary to implement evidence-based protocols. Objective: To characterize the pediatric population that was submitted to tracheostomy and compare this data to medical literacy in order to establish a follow-up and decannulation protocol. Methods: This is a retrospective and observational study with 111 children (from 1 day to 17 years old) who were submitted to tracheostomy in a tertiary Hospital over 9 years. Epidemiologic profile, surgery indications, comorbidities and the main outcomes, such as mortality and decannulation were the data collected from medical records. Results: The median age was 2 years and 2 months. The principal surgery indication was prolonged orotracheal intubation (63%). Epilepsy was present in 34% of the cases. The cannula obstruction was the main complication both for the first 7 days after surgery (10.8%) and after that period (19,8%). The sample mortality was 48.1% and the decannulation index was 11.7%. Conclusion: A follow-up protocol absence, high mortality and high rate of comorbidities were the factors that could influence the low decannulation success rate.
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Palavras-chave
Traqueostomia pediátrica, Decanulação, Traqueostomia, Pediatric tracheostomy, Decannulation, Tracheostomy