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        "resumen" => "<p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">Despite advances in non-invasive ventilation techniques&#44; tracheostomy is still indicated in children with serious airway obstruction or with the need for long-term ventilation&#46; Alternatives should be studied before deciding to tracheostomise as complications exist&#44; despite the simple procedure&#46;</p><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">The aims of this study were the identification of tracheostomised children followed in a tertiary care paediatric department&#44; the characterisation of primary disease&#44; the indications leading to tracheostomy and any complications&#46;</p><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">We present a case review of tracheostomised children followed in our department&#46;</p><p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">Sixteen tracheostomised children were followed&#44; median age of 4&#46;5 months&#44; neuromuscular disease &#8211; 5&#44; cerebral palsy &#8211; 3 and pulmonary or airway disease &#8211; 7&#46; Indications were long-term invasive ventilation &#8211; 12&#44; subglottic or tracheal stenosis &#8211; 3 and laryngomalacia &#8211; 1&#46; The most frequent complications found were persistent bacterial colonisation&#44; accidental decannulation and obstruction&#46; There was a tracheostomy-related death in 1 child&#46; Outcome&#58; 9 children maintained tracheostomy&#44; 5 were successfully decannulated and 2 children died while on tracheostomy&#46;</p><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">Tracheostomised children usually have complex disease that requires a multidisciplinary team and should be followed-up at a specialised reference centre&#46;</p>"
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        "resumen" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Apesar dos avan&#231;os nas t&#233;cnicas de ventila&#231;&#227;o n&#227;o invasiva&#44; a traqueostomia continua a ter indica&#231;&#227;o em crian&#231;as com perturba&#231;&#227;o grave da via a&#233;rea ou com necessidade de ventila&#231;&#227;o prolongada&#46; Sendo um procedimento de execu&#231;&#227;o f&#225;cil&#44; n&#227;o &#233; isenta de riscos&#44; pelo que se justifica sempre a pondera&#231;&#227;o pr&#233;via de alternativas &#224; decis&#227;o de traqueostomizar&#46;</p><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Foram objectivos deste estudo a identifica&#231;&#227;o das crian&#231;as traqueostomizadas com seguimento num servi&#231;o de pediatria de hospital terci&#225;rio&#44; a caracteriza&#231;&#227;o da doen&#231;a prim&#225;ria e indica&#231;&#245;es conducentes &#224; decis&#227;o de traqueostomizar e a avalia&#231;&#227;o das complica&#231;&#245;es registada neste grupo de doentes&#46;</p><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Procedeu-se &#224; revis&#227;o dos processos cl&#237;nicos das dezasseis crian&#231;as traqueostomizadas&#44; com uma mediana de idade &#224; data da realiza&#231;&#227;o da traqueostomia de 4&#44;5 meses&#44; cinco com doen&#231;a neuromuscular&#44; tr&#234;s com paralisia cerebral e sete com doen&#231;a pulmonar ou das vias a&#233;reas&#46; A indica&#231;&#227;o para a traqueostomia foi a necessidade de ventila&#231;&#227;o invasiva prolongada em doze casos&#44; estenose subgl&#243;tica ou traqueal em tr&#234;s e laringomalacia num outro&#46; As complica&#231;&#245;es mais frequentes foram a coloniza&#231;&#227;o bacteriana persistente&#44; a descanula&#231;&#227;o transit&#243;ria acidental e a obstru&#231;&#227;o transit&#243;ria da c&#226;nula&#46; Verificou-se um &#243;bito relacionado com a traqueostomia&#46; Nove crian&#231;as mant&#234;m traqueostomia&#44; cinco foram descanuladas &#40;uma das quais veio a falecer&#41; e outras duas faleceram ainda com traqueostomia&#46;</p><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">Tal como sublinhado na literatura&#44; as crian&#231;as e adolescentes traqueostomizados t&#234;m habitualmente patologias m&#250;ltiplas que exigem apoio multidisciplinar&#46; A complexidade das situa&#231;&#245;es cl&#237;nicas e a exig&#234;ncia de recursos determinam a necessidade de acompanhamento em centro especializado de refer&#234;ncia&#46;</p>"
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Tracheostomy: Indications and complications in paediatric patients
Traqueostomia: Indicações e complicações em doentes pediátricos
Artur Sousa1, Teresa Nunes2,
Corresponding author
teresanunes@sapo.pt

Correspondence to/Correspondência: Unidade de Pneumologia, Clínica Universitária de Pediatria, Hospital de Santa Maria, Lisboa.
, Rosa Roque Farinha3, Teresa Bandeira4, Doutor J C Gomes-Pedro5
1 Interno do internato complementar de pediatria do Hospital de Santa Maria / Resident, Paediatrics, Hospital de Santa Maria
2 Assistente hospitalar do Departamento da Criança e da Família do Hospital de Santa Maria, assistente da Clínica Universitária de Pediatria da Faculdade de Medicina de Lisboa / Consultant, Family and Child Unit, Hospital de Santa Maria; Consultant, University Paediatrics Clinic, Lisbon University Faculty of Medicine
3 Assistente hospitalar graduada do Serviço de Otorrinolaringologia do Hospital de Santa Maria, professora auxiliar coordenadora da disciplina de Otorrinolaringologia da Faculdade de Medicina da Universidade da Beira Interior / Consultant, ENT Specialist, Hospital de Santa Maria; Assistant Professor, Coordinator ENT, Beira Interior University Faculty of Medicine
4 Assistente hospitalar graduada do Departamento da Criança e da Família do Hospital de Santa Maria, assistente da Clínica Universitária de Pediatria da Faculdade de Medicina de Lisboa / Consultant, Specialist, Family and Child Unit, Hospital de Santa Maria; Consultant, University Paediatrics Clinic, Lisbon University Faculty of Medicine
5 Instituição / Instituition: Unidade de Pneumologia, Departamento da Criança e da Família, Hospital de Santa Maria
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        "titulo" => "Traqueostomia&#58; Indica&#231;&#245;es e complica&#231;&#245;es em doentes pedi&#225;tricos"
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        "resumen" => "<p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">Despite advances in non-invasive ventilation techniques&#44; tracheostomy is still indicated in children with serious airway obstruction or with the need for long-term ventilation&#46; Alternatives should be studied before deciding to tracheostomise as complications exist&#44; despite the simple procedure&#46;</p><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">The aims of this study were the identification of tracheostomised children followed in a tertiary care paediatric department&#44; the characterisation of primary disease&#44; the indications leading to tracheostomy and any complications&#46;</p><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">We present a case review of tracheostomised children followed in our department&#46;</p><p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">Sixteen tracheostomised children were followed&#44; median age of 4&#46;5 months&#44; neuromuscular disease &#8211; 5&#44; cerebral palsy &#8211; 3 and pulmonary or airway disease &#8211; 7&#46; Indications were long-term invasive ventilation &#8211; 12&#44; subglottic or tracheal stenosis &#8211; 3 and laryngomalacia &#8211; 1&#46; The most frequent complications found were persistent bacterial colonisation&#44; accidental decannulation and obstruction&#46; There was a tracheostomy-related death in 1 child&#46; Outcome&#58; 9 children maintained tracheostomy&#44; 5 were successfully decannulated and 2 children died while on tracheostomy&#46;</p><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">Tracheostomised children usually have complex disease that requires a multidisciplinary team and should be followed-up at a specialised reference centre&#46;</p>"
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        "resumen" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Apesar dos avan&#231;os nas t&#233;cnicas de ventila&#231;&#227;o n&#227;o invasiva&#44; a traqueostomia continua a ter indica&#231;&#227;o em crian&#231;as com perturba&#231;&#227;o grave da via a&#233;rea ou com necessidade de ventila&#231;&#227;o prolongada&#46; Sendo um procedimento de execu&#231;&#227;o f&#225;cil&#44; n&#227;o &#233; isenta de riscos&#44; pelo que se justifica sempre a pondera&#231;&#227;o pr&#233;via de alternativas &#224; decis&#227;o de traqueostomizar&#46;</p><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Foram objectivos deste estudo a identifica&#231;&#227;o das crian&#231;as traqueostomizadas com seguimento num servi&#231;o de pediatria de hospital terci&#225;rio&#44; a caracteriza&#231;&#227;o da doen&#231;a prim&#225;ria e indica&#231;&#245;es conducentes &#224; decis&#227;o de traqueostomizar e a avalia&#231;&#227;o das complica&#231;&#245;es registada neste grupo de doentes&#46;</p><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Procedeu-se &#224; revis&#227;o dos processos cl&#237;nicos das dezasseis crian&#231;as traqueostomizadas&#44; com uma mediana de idade &#224; data da realiza&#231;&#227;o da traqueostomia de 4&#44;5 meses&#44; cinco com doen&#231;a neuromuscular&#44; tr&#234;s com paralisia cerebral e sete com doen&#231;a pulmonar ou das vias a&#233;reas&#46; A indica&#231;&#227;o para a traqueostomia foi a necessidade de ventila&#231;&#227;o invasiva prolongada em doze casos&#44; estenose subgl&#243;tica ou traqueal em tr&#234;s e laringomalacia num outro&#46; As complica&#231;&#245;es mais frequentes foram a coloniza&#231;&#227;o bacteriana persistente&#44; a descanula&#231;&#227;o transit&#243;ria acidental e a obstru&#231;&#227;o transit&#243;ria da c&#226;nula&#46; Verificou-se um &#243;bito relacionado com a traqueostomia&#46; Nove crian&#231;as mant&#234;m traqueostomia&#44; cinco foram descanuladas &#40;uma das quais veio a falecer&#41; e outras duas faleceram ainda com traqueostomia&#46;</p><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">Tal como sublinhado na literatura&#44; as crian&#231;as e adolescentes traqueostomizados t&#234;m habitualmente patologias m&#250;ltiplas que exigem apoio multidisciplinar&#46; A complexidade das situa&#231;&#245;es cl&#237;nicas e a exig&#234;ncia de recursos determinam a necessidade de acompanhamento em centro especializado de refer&#234;ncia&#46;</p>"
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Pulmonology

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