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Pediatric-Onset Rehabilitation

Trachea Support

Author, Year

Country

Study Design

Sample Size

Population

Intervention

Outcome Measure

Results

(Behl & Watt, 2005)

United Kingdom

Observational

N=9

Population: Mean age: 5.9 (1.5-13.8) yr; Gender: males=7, females=2; Mean time since injury: 7 yr.

Intervention: None. Retrospective Audit.

Outcome Measures: Inside diameter (ID), outside diameter (OD), lateral tracheal diameter (LTD).

1.         Following rehabilitation and discharge, all children were being ventilated at home on room air; the majority were on mechanical ventilation using the Puritan Bennett Companion 2801 ventilator, one used the Breas 501 ventilator with a pressure-limiting valve and one used the Breas 401 ventilator.

2.        The IDs of all the tubes used ranged from 4.0 to 7.0 mm in incremental steps of 0.5 mm, and the ODs ranged from 6.0 to 10.7 mm in unequal steps because of material differences.

3.        There was a steady increase in tracheostomy tube ID with increasing age (p<0.01); this was expressed by the relationship: ID=(agex0.3) + 3.5.

4.        OD also related to age (p<0.01); this was expressed by the relationship: OD=(agex0.3) + 5.5.

5.        LTD was increased with increasing age (p<0.01); this was expressed by the relationship LTD=(agex1.2) + 4.6.

6.        ID correlated closely with weight (p<0.01); this was expressed by the relationship ID=(weightx0.08) + 3.1.

7.        OD correlated well with weight (p<0.01); this was expressed by the relationship OD=(weightx0.1) + 4.7.

8.        LTD also showed good correlation with weight (p<0.01); this was expressed by the relationship LTD=(weightx0.3) + 2.7.

Discussion

Behl (2005) described the long-term tracheostomy tube management in a retrospective cohort of 9 children with ventilator dependency observed over an average of 7 years; they required tracheostomy tube increases about every 2 years. Tracheal size (internal, external, and lateral) correlated with age and weight, but the correlation with age was more reliable as the weight was harder to predict because of stunted growth and immobility. In addition, the paper noted that 4/9 of children needed tracheostomy dilatation in order to insert the larger tracheostomy tube.

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