Résumé
Tracheostomy is the surgical procedure originally described in 1[st] century BC. It is the life saving procedure when performed with appropriate indications and surgical technique. Tracheostomy in the pediatric population is a particularly hazardous procedure. Retrospective chart review This study was conducted at the Peoples University of Medical and Health Sciences Hospital Nawabshah between 2004 to 2008. Retrospective review of pediatric tracheostomy done in emergency or elective procedure under general anesthesia or local anesthesia was under taken. Name, age, indications, time of decanulation and follow up were evaluated. 31 Pediatric patients had tracheostomies within study period. There were 19 males and 12 females. Age range was 2 months to 10 years. The most common indication of tracheostomy was upper respiratory tract obstruction due to traumatic causes [54.83%]. 83.87% tracheostomies were done in emergency while 16.12% as elective procedure under general anesthesia or local anesthesia. Complications were encountered in 32.25%of patients. Most frequent complication was granulation tissue formation in the area around stoma [30%]. Complication rate was high in patients below 2 years of age [63%] and in patients having emergency tracheostomy [73.9%]. Decanulation was successfully done in all alive patients [87%]. Overall mortality rate was 12.9%. There was no tracheostomy related mortality. The indications for pediatric tracheostomy are changed from airway obstruction due to infection to trauma. Complication rate of tracheostomy is higher in younger age groups. Mortality and outcome of these patients depends primarily on underlying medical condition of the patient, otherwise pediatric tracheostomy is safe when performed in tertiary hospital settings
Résumé
The aim of this descriptive, case series study was to study demographics, clinical features and outcome of paraphenylene diamine [PPD] [commonly known by local people as 'kala pathar'] poisoning admitted to our intensive care unit [ICU] from June 2009 and May 2012. All cases of PPD poisoning admitted to ICU of the Peoples Medical College Hospital, Nawabshah, between June 2009 and May 2012 were included in this study. Demographic features, clinical features and outcome of patients were recorded. A total of 16 poisoning cases were admitted to the ICU. The mean age was 25.87 +/- 5.59 years; a majority of the patients were young females [21-30 years] and belonged to a low socioeconomic class. The main cause was intentional suicidal ingestion. Cervicofacial edema, throat pain, dysphagia, dysphonia, and stridor were the earliest clinical findings. Rhabdomyolysis, hepatitis and acute renal failure dominated the clinical picture during the later course of poisoning. Active pharmacological intervention, elective tracheostomy and assisted ventilation were the therapeutic measures required for survival. A high mortality rate [37.5%] was observed in the study. Paraphenylene diamine [PPD] poisoning is associated with high morbidity and mortality