Traqueotomía pediátrica: la experiencia de un centro terciario en Portugal

espanolBackground: A tracheostomy in a pediatric patient is a very different procedure from the one in an adult patient and is associated with specific risks in this age group. In the past, acute inflammatory airway obstruction was the main indication. Nonetheless, nowadays, the most common indication for this procedure is prolonged ventilation. The age group in which the procedure is most frequently performed also changed, with a peak incidence in patients under 1-year-old, according to the most recent studies. Methods: We retrospectively analysed all clinical data from patients under 15 years of age who had the need for a tracheostomy at our institution - a tertiary care centre - between January 2009 and December 2016. Results: Fifteen children submitted to tracheostomy in this period were identified and studied. Eleven (73%) were done in infants. The procedure was elective in 10 patients (67%). The main indications of tracheostomy were prolonged mechanical ventilation in 9 cases (60%) and airway obstruction in 6 cases (40%). Six patients (40%) were totally dependent on mechanical ventilation and five (33%) used non-invasive sleep ventilations postoperatively. No intraoperative complications were observed. Postoperative complications occurred in 47%. There were 2 deaths, one of them related to a late complication from the procedure. Five children (33%) were successfully decannulated. Conclusions: In the last years there were changes in pediatric tracheostomy indications. The decision to perform a tracheostomy remains very complex. This is a safe procedure when performed with an appropriate technique, experienced surgeons and good postoperative care. EnglishIntroduccion: Una traqueotomia en un paciente pediatrico es un procedimiento muy diferente al de un paciente adulto y esta asociado con riesgos especificos en este grupo de edad. Hoy en dia, la indicacion mas comun para este procedimiento es la ventilacion prolongada. El grupo de edad en el que se realiza el procedimiento con mas frecuencia tambien cambio, con un pico de incidencia en pacientes menores de 1 ano. Metodos: Se analizaron retrospectivamente todos los datos clinicos de pacientes menores de 15 anos que tuvieran necesidad de una traqueotomia en nuestra institucion - un centro terciario - entre enero de 2009 y diciembre de 2016. Resultados: Se identificaron 15 ninos sometidos a traqueotomia en este periodo. Once (73%) se realizaron en lactantes. El procedimiento fue electivo en 10 pacientes (67%). Las principales indicaciones de la traqueotomia fueron ventilacion mecanica prolongada en 9 casos (60%) y obstruccion de la via aerea en 6 casos (40%). Seis pacientes (40%) dependian totalmente de la ventilacion mecanica y cinco (33%) utilizaron ventilacion no invasiva durante el postoperatorio. No se observaron complicaciones intraoperatorias. Las complicaciones postoperatorias ocurrieron en el 47%. Hubo 2 muertes, una de ellas relacionada con una complicacion tardia del procedimiento. Cinco ninos (33%) fueron decanulados con exito. Conclusiones: En los ultimos anos hubo cambios en las indicaciones de la traqueotomia pediatrica. La decision de realizar una traqueotomia sigue siendo muy compleja. Este es un procedimiento seguro cuando se realiza con una tecnica adecuada, cirujanos experimentados y buen cuidado postoperatorio