Abstract：
OBJECTIVE: Percutaneous tracheostomy is routinely performed in adult patients but is seldomly used in the pediatric population due to concerns regarding safety and limited available evidence. This study aims to consolidate the current literature on percutaneous tracheostomy in the pediatric population.
METHODS: A systematic review following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines was conducted. MEDLINE, EMBASE, CINAHL, and Web of Science were searched for studies on pediatric percutaneous tracheostomy (age ≤18). The Joanna Briggs Institute and ROBINS-I tools were used for quality appraisal.
RESULTS: Twenty-one articles were included resulting in 143 patients. Patient age ranged from 2 days to 17 years, with the largest subpopulation of patients (n = 57, 40 %) being adolescents (age between 12 and 17 years old). Main indications for percutaneous tracheostomy included prolonged ventilation (n = 6), respiratory insufficiency (n = 5), and upper airway obstruction (n = 5). One-third (n = 47) of percutaneous tracheostomies were completed at the bedside in an intensive care unit. Select studies reported on surgical time and time from intubation to tracheostomy with a mean of 13.8 (SD = 7.8) minutes (n = 27) and 8.9 (SD = 2.8) days (n = 35), respectively. Major postoperative complications included tracheoesophageal fistula (n = 4, 2.8 %) and pneumothorax (n = 3, 2.1 %). There were four conversions to open tracheostomy.
CONCLUSIONS: Percutaneous tracheostomy had a similar risk of complications to open surgical tracheostomy in children and adolescents and can be performed at the bedside in a select group of patients if necessary. However, we feel that consideration must be given to the varying anatomical considerations in children and adolescents compared with adults, and therefore suggest that this procedure be reserved for adolescent patients with a thin body habitus and clearly demarcated and palpable anatomical landmarks who require a tracheostomy. When performed, we strongly support using endoscopic guidance and a surgeon who has the ability to convert to an open tracheostomy if required.
METHODS: A systematic review following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines was conducted. MEDLINE, EMBASE, CINAHL, and Web of Science were searched for studies on pediatric percutaneous tracheostomy (age ≤18). The Joanna Briggs Institute and ROBINS-I tools were used for quality appraisal.
RESULTS: Twenty-one articles were included resulting in 143 patients. Patient age ranged from 2 days to 17 years, with the largest subpopulation of patients (n = 57, 40 %) being adolescents (age between 12 and 17 years old). Main indications for percutaneous tracheostomy included prolonged ventilation (n = 6), respiratory insufficiency (n = 5), and upper airway obstruction (n = 5). One-third (n = 47) of percutaneous tracheostomies were completed at the bedside in an intensive care unit. Select studies reported on surgical time and time from intubation to tracheostomy with a mean of 13.8 (SD = 7.8) minutes (n = 27) and 8.9 (SD = 2.8) days (n = 35), respectively. Major postoperative complications included tracheoesophageal fistula (n = 4, 2.8 %) and pneumothorax (n = 3, 2.1 %). There were four conversions to open tracheostomy.
CONCLUSIONS: Percutaneous tracheostomy had a similar risk of complications to open surgical tracheostomy in children and adolescents and can be performed at the bedside in a select group of patients if necessary. However, we feel that consideration must be given to the varying anatomical considerations in children and adolescents compared with adults, and therefore suggest that this procedure be reserved for adolescent patients with a thin body habitus and clearly demarcated and palpable anatomical landmarks who require a tracheostomy. When performed, we strongly support using endoscopic guidance and a surgeon who has the ability to convert to an open tracheostomy if required.
摘要：
目的：经皮气管切开术通常在成人患者中进行，但由于对安全性的担忧和有限的现有证据，很少在儿科人群中使用。本研究旨在巩固儿科人群经皮气管切开术的最新文献。
方法：按照系统评价和Meta分析指南的首选报告项目进行系统评价。MEDLINE,EMBASE,CINAHL,和WebofScience进行了有关小儿经皮气管切开术（年龄≤18岁）的研究。JoannaBriggs研究所和ROBINS-I工具用于质量评估。
结果：共纳入21篇文献，共纳入143例患者。患者年龄从2天到17岁，最大的患者亚群（n=57，40％）是青少年（年龄在12至17岁之间）。经皮气管切开术的主要适应症包括长时间通气（n=6），呼吸功能不全（n=5），和上呼吸道阻塞（n=5）。三分之一（n=47）的经皮气管切开术在重症监护病房的床边完成。选择报告的手术时间和从插管到气管造口术的时间的研究，平均为13.8（SD=7.8）分钟（n=27）和8.9（SD=2.8）天（n=35），分别。术后主要并发症包括气管食管瘘（n=4，2.8％）和气胸（n=3，2.1％）。有四次转换为开放式气管造口术。
结论：在儿童和青少年中，经皮气管切开术与开放式外科气管切开术有相似的并发症风险，必要时可在部分患者床边进行。然而,我们认为，与成年人相比，必须考虑儿童和青少年的不同解剖学考虑，因此，建议将此程序保留给身材瘦弱，需要气管造口术的清晰分界和可触知的解剖标志的青少年患者。执行时，我们强烈支持使用内窥镜引导和外科医生,如果需要,他们有能力转换为开放式气管造口术.
方法：按照系统评价和Meta分析指南的首选报告项目进行系统评价。MEDLINE,EMBASE,CINAHL,和WebofScience进行了有关小儿经皮气管切开术（年龄≤18岁）的研究。JoannaBriggs研究所和ROBINS-I工具用于质量评估。
结果：共纳入21篇文献，共纳入143例患者。患者年龄从2天到17岁，最大的患者亚群（n=57，40％）是青少年（年龄在12至17岁之间）。经皮气管切开术的主要适应症包括长时间通气（n=6），呼吸功能不全（n=5），和上呼吸道阻塞（n=5）。三分之一（n=47）的经皮气管切开术在重症监护病房的床边完成。选择报告的手术时间和从插管到气管造口术的时间的研究，平均为13.8（SD=7.8）分钟（n=27）和8.9（SD=2.8）天（n=35），分别。术后主要并发症包括气管食管瘘（n=4，2.8％）和气胸（n=3，2.1％）。有四次转换为开放式气管造口术。
结论：在儿童和青少年中，经皮气管切开术与开放式外科气管切开术有相似的并发症风险，必要时可在部分患者床边进行。然而,我们认为，与成年人相比，必须考虑儿童和青少年的不同解剖学考虑，因此，建议将此程序保留给身材瘦弱，需要气管造口术的清晰分界和可触知的解剖标志的青少年患者。执行时，我们强烈支持使用内窥镜引导和外科医生,如果需要,他们有能力转换为开放式气管造口术.
