Neurological Etiologies Necessitating Elective Tracheostomy in Pediatric Age Group: A 100 Patient Experience
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Abstract
Background: Tracheostomy is a life-saving procedure and is indicated in a variety of peripheral or central conditions leading to respiratory compromise. Mainly, tracheostomy is done for three reasons; to bypass obstructed upper airway, to remove secretions and keep the airway patent; and to effectively ventilate the patient.
Objective: The aim of this study is to quantify the frequency of different neurological disorders which indicate elective tracheostomy to avoid respiratory compromise and its associated complications.
Materials and Methods: In this Prospective, observational study, 100 pediatric patients with confirmed neurological diagnosis and associated severe respiratory impairment requiring invasive mechanical ventilation were enrolled. The study was conducted over the period of 3 months, from May 2022 to July 2022, at Children Hospital and Institute of Child Health, Lahore.
Results: According to the collected data, prevalence of male patients was almost twice as that of females (2.9:1). The main indication of tracheostomy was the requirement of prolonged mechanical ventilation due to neurological condition (n= 36, p<0.02). Among all the neurological etiologies, the CNS infections with serious respiratory manifestations were most common including Guillain Barre Syndrome (n=26, p=<0.01), Diphtheria Polyneuropathy (n=8, p=0.06), Hypoxic-Ischemic Encephalopathy (n=5, p<0.08), Varicella Zoster Infection (n=3, p=0.09), Poliomyelitis / Post-Polio Syndrome (n=2, p<0.1), and Tetanus (n=1, p=0.15).
Conclusion: Infectious neurological diseases such as GBS, Diphtheria, and polio, causing respiratory failure are still prevalent in developing countries like Pakistan & India and are the main causes of tracheostomy in pediatric age group. Prolonged mechanical ventilation was the main indication for tracheostomy.