Experience of the Tracheostomy Clinic of the National Children Hospital ""Dr. Carlos Saenz Herrera"", January 2003- July 2007

Abstract

Background: The tracheostomy was performed in a large group of pediatric patients, but no published studies. The objective of this research is to describe the epidemiological and clinical characteristics of the population traqueostomized during the study period, to improve based on the findings, the general pattern of management.
Materials and methods: A retrospective review of the population traqueostomized since 2003 to the first half of 2007 to quantify the performance of the tracheostomy, history of hospitalizations, use of prophylactic treatment, history of decanulations, decanulations failures, cause of death and the technical classification of the population attending the clinic of tracheostomy. We included 50 patients who attended at least one consultation during the study period and data were collected: age, sex, cause of realization of a tracheostomy, tracheostomy complications, germs that cause local infection, treatment, associated diseases, equipment costs and materials for release.
Results: On average 28 tracheotomy were performed per year. The group that is ethereal tracheostomy was placed over 1 to 3 years, with predominance in males (M: F, 11:6), 36% for cerebral palsy child; 33% of patients are decanulation, there were 15% decanulations failures. Mortality occurred in 20% of patients, for reasons unrelated to the tracheostomy.
The most common germ causing infection was Pseudomona Aureoginosa (54%); 22% of patients with positive cultures using prophylactic antibiotics; 16% of patients hospitalized for problems associated with tracheostomy. In 88% of cases the principal caregiver is the mother of which 72% were married, 56% had incomplete primary. The cost of equipment and materials necessary for the discharge from the hospital and home care was very high.
Conclusions: The tracheostomy is a procedure common in pediatric practice in a specialized hospital, more and more useful for the handling of the complicated child that requires chronic ventilatory assistance. The organization of the Clinic allowed follow-up bronchoscopy of traqueostomized patients with increase in decanulations, establishing criteria for the management of local infection. The use of prophylactic antibiotic treatment resulted in a decrease in the number of hospitalizations in this group of children.
The cost of equipment and materials necessary for the discharge of the child traqueostomized to his home is high for the institution, but offers the patient the possibility of family integration.