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Tracheostomy practices in children on mechanical ventilation: a systematic review and meta-analysis
Araujo, Orlei Ribeiro de; Azevedo, Rafael Teixeira; Oliveira, Felipe Rezende Caino de; Colleti Junior, José.
  • Araujo, Orlei Ribeiro de; Instituto de Oncologia Pediátrica de São Paulo - GRAACC. São Paulo. BR
  • Azevedo, Rafael Teixeira; Instituto de Oncologia Pediátrica de São Paulo - GRAACC. São Paulo. BR
  • Oliveira, Felipe Rezende Caino de; Instituto de Oncologia Pediátrica de São Paulo - GRAACC. São Paulo. BR
  • Colleti Junior, José; Hospital Alvorada Moema. Departamento de Pediatria. São Paulo. BR
J. pediatr. (Rio J.) ; 98(2): 126-135, March-Apr. 2022. tab, graf
Article in English | LILACS-Express | LILACS | ID: biblio-1375775
ABSTRACT
Abstract

Objective:

To evaluate current practices of tracheostomy in children regarding the ideal timing of tracheostomy placement, complications, indications, mortality, and success in decannulation. Source of data The authors searched PubMed, Embase, Cochrane Library, Google Scholar, and complemented by manual search. The guidelines of PRISMA and MOOSE were applied. The quality of the included studies was evaluated with the Newcastle-Ottawa Scale. Information extracted included patients' characteristics, outcomes, time to tracheostomy, and associated complications. Odds ratios (ORs) with 95% CIs were computed using theMantel-Haenszel method. Synthesis of data Sixty-six articles were included in the qualitative analysis, and 8 were included in the meta-analysis about timing for tracheostomy placement. The risk ratio for "death in hospital outcome" did not show any benefit from performing a tracheostomy before or after 14 days of mechanical ventilation (p = 0.49). The early tracheostomy before 14 days had a great impact on the days of mechanical ventilation (-26 days in mean difference, p < 0.00001). The authors also found a great reduction in hospital length of stay (-31.4 days, p < 0.008). For the days in PICU, the mean reduction was of 14.7 days (p < 0.007).

Conclusions:

The meta-analysis suggests that tracheostomy performed in the first 14 days of ventilation can reduce the time spent on the ventilator, and the length of stay in the hospital, with no effect on mortality. The decision to perform a tracheostomy early or late may be more dependent on the baseline disease than on the time spent on ventilation.


Full text: Available Index: LILACS (Americas) Type of study: Practice guideline / Prognostic study / Qualitative research / Systematic reviews Language: English Journal: J. pediatr. (Rio J.) Journal subject: Pediatrics Year: 2022 Type: Article Affiliation country: Brazil Institution/Affiliation country: Hospital Alvorada Moema/BR / Instituto de Oncologia Pediátrica de São Paulo - GRAACC/BR

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Full text: Available Index: LILACS (Americas) Type of study: Practice guideline / Prognostic study / Qualitative research / Systematic reviews Language: English Journal: J. pediatr. (Rio J.) Journal subject: Pediatrics Year: 2022 Type: Article Affiliation country: Brazil Institution/Affiliation country: Hospital Alvorada Moema/BR / Instituto de Oncologia Pediátrica de São Paulo - GRAACC/BR