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

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 we...

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Detalles Bibliográficos
Autores principales: Antunes, Letícia Alves, Talini, Carolina, de Carvalho, Bruna Cecília Neves, Guerra, Jessica Pareja, Aristides, Ewerton dos Santos, de Oliveira, Darken Eugênio, Avilla, Sylvio Gilberto Andrade
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Instituto Israelita de Ensino e Pesquisa Albert Einstein 2019
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6550435/
https://www.ncbi.nlm.nih.gov/pubmed/31166409
http://dx.doi.org/10.31744/einstein_journal/2019AO4467
Descripción
Sumario: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 χ(2) 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.