Complications of Tracheostomy in Patients with Severe Motor and Intellectual Disabilities and Their Management

DOI PubMed 3 Citations 9 References
  • Kotani Haruko
    Departments of Pediatrics National Hospital Organization Kochi Hospital
  • Hino Hiroyuki
    Departments of Thoracic Surgery, National Hospital Organization Kochi Hospital
  • Takechi Tomoki
    Departments of Pediatrics National Hospital Organization Kochi Hospital
  • Shiraishi Taisuke
    Departments of Pediatrics National Hospital Organization Kochi Hospital
  • Ogura Hideo
    Departments of Pediatrics National Hospital Organization Kochi Hospital

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Other Title
  • 重症心身障害児（者）における気管切開の合併症とその対策についての検討

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Abstract

Some patient with severe motor and intellectual disabilities have a narrow mediastinum due to severe scoliosis or thoracic deformity. Complication of tracheostomy in these patients, such as granulation of the lower end of the cannula and tracheo-innominate artery fistulae, are difficult to treat. The causes of recurrent respiratory distress after tracheostomy in four patients with severe motor and intellectual disabilities were investigated, and its management was evaluated based on chest CT and bronchoscopy. In all patients, the lower end of the cannula was in contact with the site of tracheal stenosis, accompanied by granulation with arterial pulsation. In three patients, tracheomalacia as a complication of tracheostomy was also noted. In three patients, changing the cannula to fix its lower end proximally to the lesion, combined with stent placement in one patient with tracheomalacia, resulted in regression of the granulation and respiratory distress. However, one patient with severe tracheomalacia, who had been treated by stent placement alone, died of tracheo-innominate artery fistula. To prevent complications of tracheostomy in patients with severe motor and intellectual disabilities, it is important to select cannulas with a suitable length and angle. In the absence of severe tracheomalacia, use of custom-made short cannulas that can be fixed proximally to the site of stenosis and to the proximity of arteries are appropriate for this purpose.

Journal

  • NO TO HATATSU

    NO TO HATATSU 37 (6), 473-478, 2005

    THE JAPANESE SOCIETY OF CHILD NEUROLOGY

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