Upper airway manifestations of anti-IgLON5 disease: Otorhinolaryngological point of view.

INTRODUCTION: Anti-IgLON5 disease is a recently described neurological disorder with multisystemic features. The disease is characterized by the presence of IgLON5 antibodies in serum and cerebrospinal fluid. Our objective is to describe in detail the otorhinolaryngological manifestations of this disease, which are frequent and may include dysphagia, dysarthria, vocal cord paralysis and laryngospasm. METHODS: In this study, we present a series of 9 patients with anti-IgLON5 disease and otolaryngological manifestations. Patients were evaluated between July 2012 and March 2022 by video-polysomnography, fiber-optic laryngoscopy, and functional endoscopic evaluation of swallowing. RESULTS: The median age was 71 years, and 5 (56%) were female. Video-polysomnography showed a NREM/REM parasomnia in 6 patients (67%), obstructive sleep apnea in 8 (88%), stridor during sleep in 7 (78%) and central apneas in 1 (11%). Six out of the 9 patients (67%) presented episodes of acute respiratory failure that required mechanical ventilation, 6 had vocal fold palsy with 4 of them requiring tracheostomy (3 had to be performed on an emergency basis). Dysphagia occurred in 8 patients (89%). Prominent upper airway secretion and sialorrhea was also present in 3 cases. CONCLUSION: The anti-IgLON5 disease exhibits extensive otolaryngological symptoms, mainly affecting the upper airway. These symptoms affect the quality of life and can be life-threatening. Prompt acute management is essential for stridor, dyspnea, and dysphagia. Given the potential severity of the symptoms and rarity of the disease, it is important for otolaryngologists to be familiar with anti-IgLON5 disease. LEVEL OF EVIDENCE: Level 4.

Characteristics of tracheostomized patients followed up by a Palliative Care and Complex Chronic Patient Service.

INTRODUCTION AND OBJECTIVES: In recent years, there has been an increase in the number of children with tracheostomies. The objective was to describe the characteristics of paediatric patients with a tracheostomy followed up by the Department of Palliative Care and Chronic Medically Complex Illness (DPCCMCI) of a tertiary care hospital. METHODS: Single-centre retrospective observational study in patients aged less than 18 years with a tracheostomy followed up by the PCCCPS of a tertiary care hospital (November 2020-June 2022). We analysed epidemiological, clinical, microbiological and social data by reviewing the health records. RESULTS: The sample included 44 tracheostomized patients. The most frequent underlying disease was acquired upper airway disease (20.5%). The most common indication for tracheostomy was upper airway obstruction (66%). Bacterial isolates were detected in 84% of the tracheal aspirates, among which P. aeruginosa was the most frequent (56.8%). The most frequently prescribed antibiotic was ciprofloxacin (84%). In addition, 18.1% of the patients received at least 1 course of intravenous antibiotherapy and 29.5% received more than 3 systemic antibiotic regimens in the past 20 months. Fifty-nine percent of the children were schooled: 38.6% attended a regular school, 15.9% a special needs school and 4.5% were home-schooled. We identified social difficulties in 53.7%. Also, 22.7% of the families received financial support to care for a child with severe illness. CONCLUSIONS: Because of the complexity of caring for tracheostomized children, integral and coordinated management is essential. Schooling is possible and safe if caregivers are trained.

Tracheotomy versus tracheostomy, the need for lexicographical clarification.

In the healthcare field, the terms "traqueotomía" and "traqueostomía" are frequently used, often leading to confusion among professionals regarding the appropriate definition for each term or which one should be considered more correct in specific cases. A search was conducted for the terms "traqueotomía" and "traqueostomía" in general Spanish-language dictionaries such as the Dictionary of the Royal Spanish Academy (DRAE) and the Historical Dictionary of the Spanish Language of the Royal Spanish Academy (DHLE), as well as for the English terms "tracheotomy" and "tracheostomy" in English general dictionaries like the Oxford Dictionary, the Cambridge Dictionary, and the Collins English Dictionary. Additionally, searches were performed in medical dictionaries in both Spanish, specifically the Dictionary of Medical Terms of the National Academy of Medicine (DTM), and English, including the Farlex Dictionary. The terms were also explored using the Google search engine. Definitions were analyzed from both lexicographical and etymological perspectives. Definitions found in general dictionaries, in both Spanish and English, were found to be imprecise, limited, and ambiguous, as they mixed outdated indications with criteria that deviated from etymology. In contrast, definitions in medical dictionaries in both languages were more aligned with etymology. "Traqueotomía" strictly identifies the surgical procedure of creating an opening in the anterior face of the trachea. "Traqueostomía" identifies the creation of an opening that connects the trachea to the exterior, involving a modification of the upper airway by providing an additional entry for the respiratory pathway. "Traqueostomía" becomes the sole means of entry to the airway in total laryngectomies. Both terms can be used synonymously when a traqueotomía culminates in a traqueostomía. However, it is not appropriate to use the term "traqueostomía" when the procedure concludes with the closure of the planes and does not result in the creation of a stoma. Traqueostomas can be qualified with adjectives indicating permanence (temporary/permanent), size (large/small), shape (round/elliptical), or depth, without being linked to any specific disease or surgical indication. Not all permanent traqueostomas are the result of total laryngectomies, and they do not necessarily have an irreversible character systematically.

[Factors related with microbiological contamination of surgical site in patients undergoing tracheotomy]. / Factores relacionados con la contaminación microbiológica de sitio quirúrgico en pacientes traqueotomizados.

Background: Tracheotomy is a common technique; however, microbiological contamination of the surgical site can increase morbimortality. Up to 90% of patients present a positive culture of the airway. Among the most important related factors is the lack of tracheal cannula replacement and lower airway infections. It is convenient to identify microbiological contamination of surgical site in tracheal secretions samples and the specific microorganism associated. Objective: To determine the factors related to microbiological contamination of surgical site. Material and methods: A prospective cohort study which included patients undergoing tracheotomy was carried out. Tracheal secretion was sampled by direct swabbing for culture during surgery and from the surgical site 5 days after. Results: The initial report showed contamination of samples in 58.3%, and 5 days after in 80.6%, with an incidence of contamination of 22.3%. Initially the main agents identified were Pseudomonas aeruginosa in 13.9% of the cultures, Klebsiella pneumoniae in 11.1% and Enterobacter spp. in 11%. On day 5, the most common agents were Klebsiella pneumoniae in 25% of the cases, Acinetobacter baumannii in 11.1% and Pseudomonas aeruginosa in 11.1. Conclusions: The frequency of microbiological contamination is high. The main agents were Staphylococcus aureus, Klebsiella pneumoniae and Pseudomonas aeruginosa. No risk factors for the presence of post-tracheotomy contamination were identified.

Introducción: la traqueotomía es un procedimiento común; sin embargo, la contaminación microbiológica del sitio quirúrgico puede aumentar la morbimortalidad. Hasta el 90% de los pacientes presentan un cultivo positivo de la vía respiratoria. Como factores relacionados, resaltan la falta de recambio de cánulas traqueales y las infecciones de vías aéreas bajas. Es conveniente identificar la contaminación microbiológica de secreción traqueal del sitio quirúrgico y el microorganismo asociado. Objetivo: determinar los factores relacionados con la contaminación microbiológica del sitio quirúrgico. Material y métodos: se hizo un estudio de cohorte prospectiva que incluyó a pacientes sometidos a traqueotomía. Se tomó cultivo por hisopado directo de secreción traqueal durante la cirugía y del sitio quirúrgico 5 días después. Resultados: la muestra inicial mostró contaminación en 58.3% de los pacientes y a los 5 días postquirúrgicos en 80.6%, con incidencia de contaminación de 22.3%. Inicialmente se aisló Pseudomonas aeruginosa en 13.9% de los casos, Klebsiella pneumoniae en 11.1% y Enterobacter spp. en 11%. Al quinto día se aisló Klebsiella pneumoniae en 25% de los casos, Acinetobacter baumannii en 11.1% y Pseudomonas aeruginosa en 11.1%. Conclusiones: la frecuencia de contaminación microbiológica es alta y se encontraron principalmente Staphylococcus aureus, Klebsiella pneumoniae y Pseudomonas aeruginosa. No se identificaron factores de riesgo para la contaminación postquirúrgica.

Split cricoideo anterior posterior: una novedosa técnica para evitar la traqueotomía en parálisis cordal bilateral en pacientes pediátricos / Posterior anterior cricoid split: a cutting-edge technique to avoid tracheostomy in bilateral cordal paralysis in pediatric patients

Introducción: La parálisis cordal bilateral en aducción es la segunda causa de estridor congénito y genera una grave obstrucción de la vía aérea, debutando con estridor. La traqueotomía ha sido durante mucho tiempo el gold estándar para el tratamiento de esta afección, no exenta de complicaciones. Existen procedimientos que intentan evitar la traqueotomía, como el split cricoideo anterior posterior endoscópico (SCAPE). Objetivo: Presentar experiencia con SCAPE en pacientes pediátricos como tratamiento alternativo de parálisis cordal bilateral en aducción. Material y Método: Análisis retrospectivo de los resultados quirúrgicos obtenidos en pacientes con parálisis cordal bilateral en aducción tratados con SCAPE entre enero de 2016 y diciembre de 2019 en el Hospital Guillermo Grant Benavente de Concepción, Chile. Resultados: Siete pacientes se sometieron a SCAPE. Todos los pacientes presentaban insuficiencia respiratoria severa, cinco requirieron asistencia ventilatoria mecánica. Seis pacientes tenían el diagnóstico de parálisis cordal bilateral (PCB) congénita y uno PCB secundaria a tumor de tronco cerebral. Cuatro pacientes presentaron comorbilidad de la vía aérea: dos pacientes presentaron estenosis subglótica grado I y dos pacientes presentaron laringomalacia que requirió manejo quirúrgico. Los días promedio de intubación fueron once días. Ningún paciente requirió soporte ventilatorio postoperatorio, sólo un paciente recibió oxigenoterapia nocturna debido a hipoventilación secundaria a lesión de tronco. Ningún paciente ha presentado descompensación respiratoria grave. Un 40% ha recuperado movilidad cordal bilateral. Conclusión: Split cricoideo anteroposterior endoscópico es una alternativa eficaz para tratar el PCB en pacientes pediátricos. Nuestro estudio evidencia que es una alternativa a la traqueotomía, con excelentes resultados y menor morbimortalidad.

Introduction: Bilateral vocal fold paralysis in adduction is the second cause of congenital stridor and generates a serious obstruction of the airway. Tracheostomy has long been the gold standard for the treatment of this condition, but it has inherent complications. There are procedures that try to avoid tracheotomy, such as the endoscopic anterior posterior cricoid split (EAPCS). Aim: Present our experience with EAPCS in pediatric patients as a treatment for bilateral vocal fold paralysis in adduction. Material and Method: Retrospective analysis of the surgical results obtained in patients with bilateral vocal cord paralysis in adduction treated with EAPCS between January 2016 and December 2019 at Guillermo Grant Benavente Hospital in Concepción, Chile. Results: Seven patients underwent EAPCS. All patients had severe respiratory failure, five required mechanical ventilation assistance. Six patients were diagnosed with congenital bilateral cord palsy (BCP) and one BCP secondary to a brainstem tumor. Four patients had airway comorbidity: two patients had grade I subglottic stenosis and two patients had laryngomalacia that required surgical management. The average days of intubation were eleven days. No patient required post op invasive/non-invasive ventilation, only one patient received nocturnal oxygen therapy due to hypoventilation secondary to trunk injury. None of the patients has presented severe respiratory decompensation. Forty percent have recovered bilateral chordal mobility. Conclusion: SCAPE is a cutting-edge and effective alternative to treat PCB in pediatric patients. Our study shows that it is an alternative to tracheotomy, with excellent results and lower morbidity and mortality.

Manejo de la disfagia en pacientes con antecedente de infección severa por COVID-19 / Manejo de la disfagia en pacientes con antecedente de infección severa por COVID-19

de la deglución, los cuales representan todas las alteraciones del proceso fisiológico encargado de llevar el alimento desde la boca al esófago y después al estómago, salvaguardando siempre la protección de las vías respiratorias. OBJETIVO. Definir el manejo óptimo, de la disfagia en pacientes con antecedente de infección severa por COVID-19. METODOLOGÍA. Se realizó una revisión de la literatura científica en las bases de datos PubMed y Elsevier que relacionan el manejo de la disfagia y pacientes con antecedente de infección severa por SARS-CoV-2. Se obtuvo un universo de 134 artículos que cumplieron los criterios de búsqueda. Se seleccionaron 24 documentos, para ser considerados en este estudio. RESULTADOS. La incidencia de disfagia posterior a infección severa por SARS-CoV-2 fue del 23,14%, siendo la disfagia leve la más frecuente 48,0%. Los tratamientos clínicos más empleados en el manejo de la disfagia fueron rehabilitación oral y cambio de textura en la dieta en el 77,23% de los casos, mientras que el único tratamiento quirúrgico empleado fue la traqueotomía 37,31%. Un 12,68% de pacientes recuperó su función deglutoria sin un tratamiento específico. La eficacia de los tratamientos clínicos y quirúrgicos en los pacientes sobrevivientes de la infección severa por SARS-CoV-2 fue del 80,68%, con una media en el tiempo de resolución de 58 días. CONCLUSIÓN. La anamnesis es clave para el diagnóstico de disfagia post COVID-19. El tratamiento puede variar, desde un manejo conservador como cambios en la textura de la dieta hasta tratamientos más invasivos como traqueotomía para mejorar la función deglutoria.

INTRODUCTION. The difficulty to swallow or dysphagia is included within the problems of swallowing, which represent all the alterations of the physiological process in charge of carrying the food from the mouth to the esophagus, and then to the stomach, always taking into account the protection of the airways. OBJECTIVE. To define the optimal management, both clinical and surgical, for the adequate treatment of dysphagia produced as a consequence of severe SARS-CoV-2 infection. METHODOLOGY. A review of the scientific literature was carried out using both PubMed and Elsevier databases, which relate the management of dysphagia and patients with a history of severe SARS-CoV-2 infection. RESULTS. The incidence of dysphagia following severe SARS-CoV-2 infection was of 23,14%, with mild dysphagia being the most frequent 48,00%. The most frequently used clinical treatments for dysphagia management were oral rehabilitation and change in dietary texture in 77,23% of cases, while tracheotomy was the only surgical treatment used 37,31%. A total of 12,68% of patients recovered their swallowing function without specific treatment. The efficacy of clinical and surgical treatments in survivors of severe SARS-CoV-2 infection was 80,68%, with a mean resolution time of 58 days. CONCLUSION. An adequate medical history is key to the diagnosis of post-COVID-19 dysphagia. Treatment can range from conservative management such as changes in diet texture to more invasive treatments such as tracheotomy to improve swallowing function.

Dysphagia in intensive care, a real problem: analysis of risk factors.

AIMS: To identify risk factors present in patients with dysphagia in a population of critically ill patients. METHODS: Case series of a cohort of patients recruited in the intensive care unit (ICU) until hospital discharge. Patients who gave consent and met the inclusion criteria were recruited. The Volume-Viscosity clinical examination method was used for the screening of dysphagia. An uni- and bivariate statistical analysis was performed using odds ratio (OR) to detect risk factors for dysphagia. OUTCOMES: 103 patients were recruited from 401 possible. The mean age was 59,33 ± 13,23, men represented 76,7%. The severity of the sample was: APACHE II (12,74 ± 6,17) and Charlson (2,98 ± 3,31). 45,6% of patients showed dysphagia, obtaining significant OR values (p < 0,050) for the development of dysphagia: older age, neurological antecedents, COVID19, long stay in ICU and hospitalization, and the presence of tracheotomy. COVID19 patients represented 46,6% of the sample, so an analysis of this subgroup was performed, showing similar results, with a Charlson risk (OR:4,65; 95% CI:1,31-16,47; p = 0,014) and a hospital stay (OR: 8,50; 95%CI: 2,20-32,83; p < 0,001) On discharge from the ICU, 37,9% of the population still had dysphagia; 12,6% maintained this problem at hospital discharge. CONCLUSIONS: Almost half of our patients developed dysphagia. Clinical severity and the presence of tracheotomy were risk factors. We observed in patients with dysphagia a longer stay in both ICU and hospitalization.

Rehabilitación del nervio recurrente laríngeo postiroidectomía / Recurrent laryngeal nerve rehabilitation after thyroidectomy

El carcinoma papilar tiroideo es el tipo de cáncer más común de esta glándula, y su tratamiento de elección es la tiroidectomía. Entre las complicaciones asociadas resalta la parálisis de las cuerdas vocales, la cual ocurre por una lesión directa del nervio laríngeo recurrente durante la cirugía. Se presenta una paciente de 22 años de edad con este diagnóstico, a la cual se le realizó una tiroidectomía total; en el postoperatorio inmediato la paciente comenzó con estridor laríngeo intenso que requirió una traqueotomía de urgencia. En el examen físico se constató una parálisis bilateral de las cuerdas vocales y se decidió comenzar un tratamiento de rehabilitación del nervio recurrente laríngeo con laserterapia y HIVAMAT-200 como modalidades combinadas. Los resultados alcanzados con la fisioterapia fueron satisfactorios y la paciente se reintegró rápidamente a su ámbito familiar, escolar y social.

Papillary thyroid carcinoma is the most common type of cancer of this gland, and its treatment of choice is thyroidectomy. Vocal cord paralysis stands out among the associated complications, in which a direct injury to the recurrent laryngeal nerve occurs during surgery. We present a 22-year-old female patient with this diagnosis, who underwent a total thyroidectomy; in the immediate postoperative period the patient began with intense laryngeal stridor requiring an emergency tracheotomy. Physical examination revealed bilateral vocal cord paralysis and it was decided to begin rehabilitation treatment of the recurrent laryngeal nerve with laser therapy and HIVAMAT-200 as combined modalities. The results achieved with physiotherapy were satisfactory and the patient was quickly reintegrated into her family, school and social environment.

Protocol-directed weaning versus conventional weaning from mechanical ventilation for neurocritical patients in an intensive care unit: a nonrandomized quasi-experimental study / Desmame da ventilação mecânica por protocolo versus desmame convencional em pacientes neurocríticos de uma unidade de terapia intensiva: um estudo quase experimental não randomizado

ABSTRACT Objective: To investigate whether protocol-directed weaning in neurocritical patients would reduce the rate of extubation failure (as a primary outcome) and the associated complications (as a secondary outcome) compared with conventional weaning. Methods: A quasi-experimental study was conducted in a medical-surgical intensive care unit from January 2016 to December 2018. Patients aged 18 years or older with an acute neurological disease who were on mechanical ventilation > 24 hours were included. All patients included in the study were ready to wean, with no or minimal sedation, Glasgow coma score ≥ 9, spontaneous ventilatory stimulus, noradrenaline ≤ 0.2μgr/kg/ minute, fraction of inspired oxygen ≤ 0.5, positive end-expiratory pressure ≤ 5cmH2O, maximal inspiratory pressure < -20cmH2O, and occlusion pressure < 6cmH2O. Results: Ninety-four of 314 patients admitted to the intensive care unit were included (50 in the Intervention Group and 44 in the Control Group). There was no significant difference in spontaneous breathing trial failure (18% in the Intervention Group versus 34% in the Control Group, p = 0.12). More patients in the Intervention Group were extubated than in the Control Group (100% versus 79%, p = 0.01). The rate of extubation failure was not signifiantly diffrent between the groups (18% in the Intervention Group versus 17% in the Control Group; relative risk 1.02; 95%CI 0.64 - 1.61; p = 1.00). The reintubation rate was lower in the Control Group (16% in the Intervention Group versus 11% in the Control Group; relative risk 1.15; 95%CI 0.74 - 1.82; p = 0.75). The need for tracheotomy was lower in the Intervention Group [4 (8%) versus 11 (25%) in the Control Group; relative risk 0.32; 95%CI 0.11 - 0.93; p = 0.04]. At Day 28, the patients in the Intervention Group had more ventilator-free days than those in the Control Group [28 (26 - 28) days versus 26 (19 - 28) days; p = 0.01]. The total duration of mechanical ventilation was shorter in the Intervention Group than in the Control Group [5 (2 - 13) days versus 9 (3 - 22) days; p = 0.01]. There were no diffrences in the length of intensive care unit stay, 28-day free from mechanical ventilation, hospital stay or 90-day mortality. Conclusion: Considering the limitations of our study, the application of a weaning protocol for neurocritical patients led to a high percentage of extubation, a reduced need for tracheotomy and a shortened duration of mechanical ventilation. However, there was no reduction in extubation failure or the 28-day free of from mechanical ventilation compared with the Control Group. ClinicalTrials.gov Registry:NCT03128086

RESUMO Objetivo: Investigar se o desmame por protocolo em pacientes neurocríticos reduz a taxa de falha de extubação (desfecho primário) e as complicações associadas (desfecho secundário) em comparação com o desmame convencional. Métodos: Realizou-se um estudo quase experimental em uma unidade de terapia intensiva médico-cirúrgica de janeiro de 2016 a dezembro de 2018. Foram incluídos pacientes com 18 anos de idade ou mais, com doença neurológica aguda e em ventilação mecânica > 24 horas. Todos os pacientes incluídos no estudo estavam prontos para o desmame, com nenhuma ou mínima sedação, escala de coma de Glasgow ≥ 9, estímulo ventilatório espontâneo, noradrenalina ≤ 0,2μgr/kg/minuto, fração inspirada de oxigênio ≤ 0,5, pressão expiratória positiva final ≤ 5cmH2O, pressão inspiratória máxima < -20cmH2O e pressão de oclusão < 6cmH2O. Resultados: Foram incluídos 94 dos 314 pacientes admitidos à unidade de terapia intensiva, sendo 50 no Grupo Intervenção e 44 no Grupo Controle. Não houve diferença significativa na falha do ensaio respiratório espontâneo (18% no Grupo Intervenção versus 34% no Grupo Controle, p = 0,12). Foram extubados mais pacientes no Grupo Intervenção do que no Controle (100% versus 79%; p = 0,01). A taxa de falha de extubação não foi significativamente diferente entre os grupos (18% no Grupo Intervenção versus 17% no Grupo Controle, risco relativo de 1,02; IC95% 0,64 - 1,61; p = 1,00). A taxa de reintubação foi menor no Grupo Controle (16% no Grupo Intervenção versus 11% no Grupo Controle; risco relativo de 1,15; IC95% 0,74 -1,82; p = 0,75). A necessidade de traqueotomia foi menor no Grupo Intervenção [4 (8%) versus 11 (25%) no Grupo Controle; risco relativo de 0,32; IC95% 0,11 - 0,93; p = 0,04]. Aos 28 dias, os pacientes do Grupo Intervenção tinham mais dias sem ventilador do que os do Grupo Controle [28 (26 - 28) dias versus 26 (19 - 28) dias; p = 0,01]. A duração total da ventilação mecânica foi menor no Grupo Intervenção do que no Controle [5 (2 - 13) dias versus 9 (3 - 22) dias; p = 0,01]. Não houve diferenças no tempo de internação na unidade de terapia intensiva, 28 dias sem ventilação mecânica, internação hospitalar ou mortalidade em 90 dias. Conclusão: Considerando as limitações de nosso estudo, a aplicação de um protocolo de desmame em pacientes neurocríticos levou à maior proporção de extubação, à menor necessidade de traqueotomia e à menor duração da ventilação mecânica. Entretanto, não houve redução na falha de extubação ou 28 dias sem ventilação mecânica em comparação com o Grupo de Controle. Registro ClinicalTrials.gov:NCT03128086

Caracterização de traqueostomia em crianças e adolescentes em um serviço de atenção terciária / Characterization of tracheostomy in children and adolescents in a tertiary care service / Caracterización de la traqueotomía en niños y adolescentes en un servicio de tercer nivel de atención

Objetivo: descrever o perfil de indicações, comorbidades e complicações pós-operatórias precoces de crianças e adolescentes submetidos à traqueostomia em um hospital referência brasileiro. Método: estudo retrospectivo,transversale quantiativo, com análise de prontuários eletrônicos de crianças e adolescentes submetidos à traqueostomia em um hospital de Botucatu, São Paulo, Brasil, no periodo de 2013 a 2019. A amostra foi comparada mediante a divisão de presença e ausência de complicações pós-operatórias precoces, no que se refere ao sexo, idade, síndrome, óbito, caráter eletivo ou de urgência/emergência e peso ao nascer. Resultados: entre100 prontuários, 55% do sexo masculino, com média de 3,03±3,10 anos. Foram identificadas 12 diferentes síndromes em 16 pacientes. No que se refere às complicações pós-operatórias precoces, a rolha foi a mais frequente (13%), e esteve associada a presença de síndromes (p=0,01). O motivo mais identificado da traqueostomia foi a intubação orotraquealprolongada, enquanto 44% evoluíram a óbitodevido a gravidade da doença de base. Conclusão: a traqueostomia em crianças é um procedimento seguro, com indicação mais frequente por intubação prolongada, em portadores de síndromes genéticas menores de um ano de idade. Complicação como rolha é comum, associado a síndrome.

Objective: to describe the profile of indications, comorbidities and early postoperative complications of children and adolescents undergoing tracheostomy in a Brazilian referral hospital. Method: retrospective, cross-sectional and quantitative study, with analysis of electronic medical records of children and adolescents who underwent tracheostomy in a hospital in Botucatu, São Paulo, Brazil, from 2013 to 2019. The sample was compared by dividing the presence and absence of post-operative complications. early operative procedures, with regard to sex, age, syndrome, death, elective or urgency/emergency character and birth weight. Results:among 100 records, 55% were male, with an average of 3.03±3.10 years.Twelve different syndromes were identified in 16 patients. With regard to early postoperative complications, cork was the most frequent (13%) and was associated with the presence of syndromes (p=0.01). The most identified reason for tracheostomy was prolonged orotracheal intubation, while 44% died due to the severity of the underlying disease.Conclusion:pediatric tracheostomy is a safe procedure, more frequently realized due to failure of extubation, in genetic syndrome children younger than one year old. Cork is a frequent complication, associated to syndromes.

Objetivo:describirel perfil de indicaciones, comorbilidades y complicaciones postoperatorias tempranas de niños y adolescentes sometidos a traqueotomía en un hospital de referencia brasileño. Método: estudio retrospectivo, transversal y cuantitativo, con análisis de historias clínicas electrónicas de niños y adolescentes operados de traqueotomía en un hospital de Botucatu, São Paulo, Brasil, de 2013 a 2019. La muestra fue comparada dividiendo la presencia y ausencia de complicaciones postoperatorias. .procedimientos operatorios tempranos, con respecto al sexo, edad, síndrome, muerte, carácter electivo o urgencia/emergencia y peso al nacer. Resultados: entre 100 registros, 55% eran del sexo masculino, con una media de 3,03±3,10 años. Se identificaron 12 síndromes diferentes en 16 pacientes. En cuanto a las complicaciones postoperatorias tempranas, el corcho fue la más frecuente (13%) y se asoció a la presencia de síndromes (p=0,01). El motivo de traqueostomía más identificado fue la intubación orotraqueal prolongada, mientras que el 44% fallecieron debido a la gravedad de la enfermedad de base.Conclusión: la traqueotomía en niños es un procedimiento seguro, con indicación más frecuente de intubación prolongada, en pacientes con síndromes genéticos menores de un año. La complicación como el corcho es común, asociada con el síndrome.

Pandemia COVID-19: Necessidades humanas de cuidado ao paciente com traqueostomia e as intervenções de enfermagem / Pandemia de COVID-19: Necesidades de cuidado humano de pacientes con traqueostomía e intervenciones de enfermería / COVID-19 pandemic: Human care needs of patients with tracheostomy and nursing interventions

Objetivo: refletir as necessidades básicas de saúde ao paciente com traqueostomia por câncer de cabeça e pescoço no contexto da pandemia pelo coronavírus, utilizando a Teoria das Necessidades Básicas. Método: estudo teórico-reflexivo. Foram utilizados documentos do Ministério da Saúde e da Organização Pan-Americana de Saúde, assim como uma revisão da literatura na base de dados da PUBMED para que a literatura científica associasse com os documentos consultados. Resultados: as necessidades básicas de saúde afetadas foram: Psicobiológicas de oxigenação e ambiente; Psicossociais de segurança e comunicação e Psicoespirituais de religião, seguidas dos enunciados das Intervenções de Enfermagem (NIC) como oxigenoterapia, aumento da segurança do paciente, estímulo a rituais religiosos. Conclusão: a construção do saber científico na Enfermagem torna-se imperioso, para que as necessidades de saúde afetadas ao paciente com traqueostomia na pandemia da COVID-19 sejam atendidas, para promoção da saúde e da vida.(AU)

Objective: to reflect the basic health needs of patients with tracheostomy for head and neck cancer in the context of the coronavirus pandemic, using the Theory of Basic Needs. Method: This is a reflective study, carried out through a critical reading of official documents from national and international health agencies and other conceptual sources on the subject.Results: the basic health needs affected were: Psychobiological oxygenation and environment; Psychosocial security; communication and health education and Psychospirituals of religion, followed by nursing interventions of NIC activities, oxygen therapy, environmental control, increased safety, improved communication in speech deficits; encouraging religious rituals and facilitating an efficient decision-making process. Conclusion: the construction of scientific knowledge in Nursing becomes imperative, so that the health needs affected by the patient with tracheostomy in the COVID-19 Pandemic are met, to promote health and life.(AU)

Objetivo: reflejar las necesidades básicas de salud de los pacientes traqueostomizados por cáncer de cabeza y cuello en el contexto de la pandemia del coronavirus, utilizando la Teoría de las Necesidades Básicas. Método: Se trata de un estudio reflexivo, realizado a través de una lectura crítica de documentos oficiales de organismos de salud nacionales e internacionales y otras fuentes conceptuales sobre el tema. Resultados: las necesidades básicas de salud afectadas fueron: Oxigenación psicobiológica y medio ambiente; seguridad psicosocial; comunicación y educación para la salud y Psicoespirituales de la religión, seguidas de las intervenciones de enfermería de las actividades NIC, oxigenoterapia, control ambiental, aumento de la seguridad, mejora de la comunicación en los déficits del habla; fomentar los rituales religiosos y facilitar un proceso eficiente de toma de decisiones. Conclusión: la construcción del conocimiento científico en Enfermería se torna imperativa, para que sean atendidas las necesidades de salud afectadas por el paciente con traqueotomía en la Pandemia del COVID-19, para promover la salud y la vida.(AU)

Características de deglutição e ingestão oral pré e pós acompanhamento fonoaudiológico de pacientes traqueostomizados internados em um hospital universitário / Swallowing characteristics and oral intake before and after speech therapy follow-up of tracheostomized patients admitted to a university hospital / Características de deglución e ingesta oral antes y después del seguimiento logopédico de pacientes traqueostomizados ingresados en un hospital universitario

Introdução: A traqueostomia pode impactar na deglutição e gerar alterações neurofisiológicas e mecânicas. Objetivo: Analisar a funcionalidade da deglutição em pacientes traqueostomizados internados em um hospital universitário, pré e pós intervenção fonoaudiológica por meio da análise de protocolos do serviço ­ Protocolo Adaptado (base na escalaFOIS e Protocolo de Avaliação do Risco para Disfagia ­ PARD). Método: Estudo transversal, retrospectivo, analítico observacional, de abordagem quantitativa. Analisados 114 protocolos de avaliação da deglutição, verificou-se o grau de disfagia conforme a classificação de O'Neile escala FOIS em um período de quatro anos. Pesquisa aprovada pelo Comitê de Ética em Pesquisa da Instituição (29894920.5.0000.5349). Resultados: Após analisados os protocolos constataram-se que a maioria era do sexo masculino com média de idade de 54,55 anos. Observou-se a predominância das seguintes comorbidades prévias de saúde: pneumonia, hipertensão arterial sistêmica e acidente vascular encefálico isquêmico. Após o acompanhamento fonoaudiológico houve melhora da biomecânica da deglutição com mais pacientes apresentando deglutição funcional ­ um (0,9%) para 12 (10,5%), redução do número de sujeitos com disfagia grave ­ 32 (28,1%) para 17 (14,9%) e maior ingestão por via oral ­ 79 (69,3%) dos pacientes aumentaram o nível de ingestão oral conforme a escala FOIS. A maior parte da amostra apresentou boa tolerância à oclusão de traqueostomia e 60 (52,6%) progrediram para decanulação. Conclusão: A presença da traqueostomia impactou sobre a funcionalidade da deglutição, pois a maioria dos pacientes possuía algum grau de disfagia. Ressalta-se a importância da atuação fonoaudiológica no processo de reabilitação da deglutição, auxiliando no processo de decanulação.

Introduction: Tracheostomy may impact swallowing and generate neurophysiological and mechanical alterations. Objective: To analyze the swallowing functionality in tracheostomized patients admitted to a university hospital, before and after speech-language therapy intervention through the analysis of the service protocols - Adapted Protocol (based on the FOIS scale and Dysphagia Risk Assessment Protocol - PARD). Method: Cross-sectional, retrospective, analytical observational study, with a quantitative approach. We analyzed 114 swallowing assessment protocols, and checked the degree of dysphagia according to O'Neil's classification and FOISscale over a four-year period. Research approved by the Institution's Research Ethics Committee (29894920.5.0000.5349). Results: After analyzing the protocols it was found that the majority were male with a mean age of 54.55 years. A predominance of the following previous health comorbidities was observed: pneumonia, systemic arterial hypertension and ischemic stroke. After the speech-language therapy follow-up there was an improvement in swallowing biomechanics with more patients presenting functional swallowing - one (0.9%) to 12 (10.5%), reduction in the number of subjects with severe dysphagia - 32 (28.1%) to 17 (14.9%) and greater oral intake - 79 (69.3%) of the patients increased the level of oral intake according to the FOIS scale. Most of the sample showed good tolerance to tracheostomy occlusion and 60 (52.6%) progressed to decannulation. Conclusion: The presence of a tracheostomy had an impact on swallowing functionality, since most patients had some degree of dysphagia. We emphasize the importance of speech therapy in the swallowing rehabilitation process, helping in the decannulation process.

Introducción: La traqueotomía puede afectar la deglución y generar cambios neurofisiológicos y mecánicos. Objetivo: Analizar la funcionalidad de la deglución en pacientes traqueostomizados ingresados en un hospital universitario, antes y después de la intervención logopédica mediante el análisis de protocolos de servicio - Protocolo Adaptado (basado en la escala FOIS y Protocolo de Evaluación de Riesgos para Disfagia - PARD). Método: Estudio observacional analítico, transversal, retrospectivo, con enfoque cuantitativo. Tras analizar 114 protocolos de evaluación de la deglución, se verificó el grado de disfagia según la clasificación de O'Neil y la escala FOIS durante un período de cuatro años. Investigación aprobada por el Comité de Ética en Investigación de la Institución (29894920.5.0000.5349). Resultados: Tras analizar los protocolos, se encontró que la mayoría eran varones con una edad media de 54,55 años. Predominaron las siguientes comorbilidades de salud previas: neumonía, hipertensión arterial sistémica e ictus isquémico. Después del seguimiento de logopedia, hubo una mejora en la biomecánica de la deglución, con más pacientes presentando deglución funcional - uno (0,9%) a 12 (10,5%), una reducción en el número de sujetos con disfagia severa - 32 (28,1%) %) a 17 (14,9%) y mayor ingesta oral - 79 (69,3%) de los pacientes aumentaron el nivel de ingesta oral según la escala FOIS. La mayor parte de la muestra mostró buena tolerancia a la oclusión de la traqueotomía y 60 (52,6%) progresaron a decanulación. Conclusión: La presencia de traqueotomía repercutió en la funcionalidad de la deglución, ya que la mayoría de los pacientes presentaba algún grado de disfagia. Enfatiza la importancia de la logopedia en el proceso de rehabilitación de la deglución, ayudando en el proceso de decanulación.

Late bilateral vocal cord palsy following endotracheal intubation due to COVID-19 pneumonia.

Vocal cord paralysis is a rare but severe complication after orotracheal intubation. The most common cause is traumatic, due to compression of the recurrent laryngeal nerve between the orotracheal tube cuff and the thyroid cartilage. Other possible causes are direct damage to the vocal cords during intubation, dislocation of the arytenoid cartilages, or infections, especially viral infections. It is usually due to a recurrent laryngeal nerve neuropraxia, and the course is benign in most patients. We present the case of a man who developed late bilateral vocal cord paralysis after pneumonia complicated with respiratory distress due to SARS-CoV-2 that required orotracheal intubation for 11 days. He presented symptoms of dyspnea 20 days after discharge from hospital with subsequent development of stridor, requiring a tracheostomy. Due to the temporal evolution, a possible contribution of the SARS-CoV-2 infection to the picture is pointed out.

Cambios ventilatorios después de una traqueotomía en neumonía por COVID-19 / Ventilatory changes after a tracheostomy in COVID-19 pneumonia

Introducción: existe aún una controversia sobre los efectos en los parámetros ventilatorios en pacientes sometidos a una traqueotomía, y los estudios en casos de pacientes con SARS-CoV-2 son escasos. Objetivo: describir los cambios en los parámetros ventilatorios en pacientes operados de traqueotomía por SARS-CoV-2 en la unidad de cuidados intensivos (UCI). Métodos: se realizó un estudio retrospectivo, descriptivo y longitudinal en el que se incluyeron las variables como edad, sexo, comorbilidades, tiempo de intubación, parámetros ventilatorios, gasométricos y el índice de Kirby. Se utilizó estadística descriptiva con medidas de tendencia central y medidas de dispersión. Resultados: se recibieron 493 casos con COVID-19, 133 (26,35 %) ingresaron, 21 fueron operados en la UCI; el género masculino fue 76 % y edad de 56 años; la obesidad y la hipertensión fueron las comorbilidades más comunes, todos con PCR positivo; los parámetros ventilatorios preoperatorios fueron presión positiva al final de la espiración (PEEP) de 7,61 y fracción inspirada de oxígeno (FiO2) de 41,42, la gasometría fue pH de 7,42, presión parcial de oxígeno (pO2) de 95,04, presión parcial de dióxido de carbono (pCO2) de 41,47, bicarbonato (HCO3) de 29,14, saturación de oxígeno (SatO2) de 94,7 %, el índice de Kirby x = 235; y los posoperatorios (PEEP de 7,19 y FiO2 de 40,6), la gasometría fue de pH de 7.44, pO2 de 43,7, pCO2 de 87,7, HCO3 de 27,4, SatO2 de 95,23 %. Fallecieron tres pacientes, dos pacientes complicados con sangrado y un caso con decanulación accidental. El tiempo promedio de ventilación mecánica de fue de 5,7 días. Conclusiones: la traqueotomía generó cambios muy sutiles en los parámetros ventilatorios y gasométricos; sin embargo, la liberación de la ventilación mecánica fue en promedio menor a una semana, desocupando espacio en la UCI.

Introduction: Controversy continues to exist regarding the effects on ventilatory parameters in patients undergoing tracheostomy, and studies in cases with SARS-CoV-2 are scarce. Objective: To describe changes in ventilatory parameters in patients undergoing tracheostomy for SARS-CoV-2 in the intensive care unit. Methods: A retrospective, descriptive, longitudinal study was carried out. Variables such as age, sex, comorbidities, time of IOT, ventilatory parameters, blood gases and the Kirby index were included. Descriptive statistics with measures of central tendency and measures of dispersion were used. Results: n = 493 COVID-19 cases were received, n = 133 (26.35%) were admitted, 21 were operated on in the ICU, male gender was 76%, age 56 years, obesity and hypertension were the most common comorbidities, all With CRP +, the preoperative ventilatory parameters x (PEEP 7.61) and (FiO2 41.42), the blood gas was (pH 7.42), (pO2 95.04), (pCO2 41.47), ( HCO3 29.14), (Saturation O2 94.7%) and the Kirby index x = 235 and postoperative x (PEEP 7.19) and (FiO2 40.6), the blood gas was (pH 7.44), (pO2 43.7), (pCO2 87.7), (HCO3 27.4), (Saturation O2 95.23%). n = 3 died, two patients with bleeding complications and one case with accidental decannulation. The mean time of mechanical ventilation was n = 5.7 days. Conclusions: The tracheostomy generated very subtle changes in the ventilatory and gasometric parameters, however, the release of mechanical ventilation was on average less than one week, emptying space in the ICU.

Condições envolvidas na realização de traqueostomia em pacientes internados em unidade de terapia intensiva / Conditions involved in the performance of tracheostomy in intensive care unit patients / Condiciones que intervienen en la realización de la traqueotomía en pacientes ingresados en una unidad de cuidados intensivos

Objetivo: analisar as condições envolvidas na realização de traqueostomia em pacientes em ventilação mecânica, internados em Unidade de Terapia Intensiva (UTI) de hospital privado. Método: estudo analítico, transversal e retrospectivo, realizado no ano de 2017. Foram analisadas variáveis idade, sexo, principal ocupação, estado civil, classificação por sistema ou órgão acometido, dia da traqueostomização e desfecho (alta da UTI ou óbito). Os dados foram analisados no programa R versão 3.6, gerando estatísticas descritivas como: média, desvio padrão, mínimos e máximos para as variáveis quantitativas e proporções para as variáveis qualitativas. Resultados: a maioria foi constituída por pessoas do sexo masculino, casadas, procedentes da capital e com atividade laboral. Os sistemas mais acometidos foram respiratório, neurológico e gastrointestinal. Da casuística, 60% tiveram alta da UTI e 40% foram a óbito. A idade média foi de 70 anos e a mediana de 68. Os pacientes foram traqueostomizados, em média no 11,18o dia pós intubação orotraqueal. Cruzando-se variáveis, obteve-se associação somente entre desfecho (alta ou óbito) e sistema acometido. Conclusão: sugere-se a realização de novos estudos focados nos cuidados de enfermagem com pessoas traqueostomizadas. A traqueostomização constitui uma prática invasiva, que demanda cuidados e atenção especial. (AU)

Objective: To analyze the conditions involved in performing tracheostomy in patients on mechanical ventilation, admitted to the Intensive Care Unit (ICU) of a private hospital. Methods: Analytical, cross-sectional, and retrospective study, carried out in 2017. Age, sex, main occupation, marital status, classification by affected system or organ, day of tracheostomization, and outcome (discharge from the ICU or death) were analyzed. Data were analyzed using the R version 3.6 program, generating descriptive statistics such as: mean, standard deviation, minimums, and maximums for quantitative variables and proportions for qualitative variables. Results: Most were male, married, from the capital, and working. The most affected systems were respiratory, neurological, and gastrointestinal. Of the sample, 60% were discharged from the ICU, and 40% died. The mean age was 70 years, and the median was 68. Patients were tracheostomized, on average on the 11th day after orotracheal intubation. Crossing variables, there was an association only between outcome (discharge or death) and affected system. Conclusion: It is suggested to carry out further studies focused on nursing care with tracheostomized people. Tracheostomization is an invasive practice that requires special care and attention. (AU)

Objetivo: Analizar las condiciones involucradas en la realización de traqueotomía en pacientes con ventilación mecánica, admitidos en la Unidad de Cuidados Intensivos (UCI) de un hospital privado. Métodos: Estudio analítico, transversal y retrospectivo, realizado en 2017. Se analizaron: la edad, el sexo, la ocupación principal, el estado civil, la clasificación por sistema u órgano afectado, el día de la traqueostomización y el resultado (alta de la UCI o muerte). Los datos fueron analizados utilizando el programa R versión 3.6, generando resultados estadísticos descriptivas tales como: media, desviación estándar, mínimos y máximos para las variables cuantitativas y proporciones para variables cualitativas. Resultados: La mayoría eran hombres, casados, de la capital y trabajadores. Los sistemas más afectados fueron o respiratorio, o neurológico y el gastrointestinal. De la muestra, el 60% fueron dados de alta de la UCI y el 40% fallecieron. La edad media fue de 70 años y la mediana fue de 68. Los pacientes fueron traqueostomizados, en promedio de 11 al día pos intubación orotraqueal. Al cruzar las variables, solo hubo una asociación entre el resultado (alta o muerte) y el sistema afectado. Conclusion: Se sugiere realizar más estudios centrados en el cuidado de enfermería con personas traqueostomizadas. La traqueostomización es una práctica invasiva que requiere cuidados y atención especiales. (AU)

Decanulación en Paciente Pediátrica con Enfermedad Neuromuscular: reporte de caso

RESUMEN La enfermedad de multiminicores es un trastorno neuromuscular hereditario caracterizado por la presencia de múltiples 'cores' en biopsia muscular y características clínicas de una miopatía congénita. El presente caso trata de una paciente de 10 años de edad, con diagnóstico de enfermedad neuromuscular multiminicores, traqueostomizada desde los 7 años de edad por destete fallido y debilidad muscular. La paciente fue derivada al Departamento de Rehabilitación Cardio-respiratoria del hospital de Clínicas de la Facultad de Ciencias Médicas de la Universidad Nacional de Asunción, presentando en su primera evaluación dependencia crónica de oxígeno (por más de 12 meses), tos débil y no funcional con flujo pico tosido e inferior a 160 L/m, insuficiencia respiratoria crónica e hipercapnia (53 mmHg de CO2ET). Durante su seguimiento en nuestro departamento fueron seguidas las pautas de Rehabilitación Respiratoria contempladas en el Proyecto de evaluación, tratamiento y seguimiento de pacientes con Enfermedades Neuromusculares, y aprobado por el Consejo Superior de la Facultad de Ciencias Médicas de la Universidad Nacional de Asunción, dichas pautas están fundamentadas en los estudios y publicaciones científicas del Dr. John Bach (Rudgers University, Newart, Nueva Jersey-EEUU) y su equipo colaborador del Grupo Iberoamericano de Cuidados Respiratorios en Enfermedades Neuromusculares. Como resultado final del tratamiento y seguimiento aplicado por más de un año la paciente fue decanulada exitosamente, en un consultorio para pacientes ambulatorios, sin descompensaciones hemodinámicas, con una excelente tolerancia y sin requerimiento de internaciones hospitalarias.

ABSTRACT Multiminicores disease is a hereditary neuromuscular disorder characterized by the presence of multiple 'nuclei' on muscle biopsy and clinical features of a congenital myopathy. The present case concerns a 10-year-old patient, diagnosed with multiminicores disease, tracheostomized since she was seven due to failed weaning and muscle weakness. The patient was referred to the Department of Cardio-respiratory Rehabilitation of the Clínicas Hospital from the National University of Asunción, presenting in her first evaluation chronic oxygen dependence (for more than 12 months), weak and non-functional cough with cough peak flow less than 160 L / m, chronic respiratory failure and hypercapnia (52 mmHg CO2ET). We did the follow-up in order to the Respiratory Rehabilitation guidelines contemplated in the Project for the evaluation, treatment and follow-up of patients with Neuromuscular Diseases, which was approved by the Superior Council of the Medical Sciences School from the National University of Asunción, these guidelines are based on scientific studies and publications done by Dr. John Bach (Rudgers University, Newart, New Jersey-USA) and his collaborating team from the Ibero-American Group for Respiratory Care in Neuromuscular Diseases. As a result, the patient was successfully decannulated, in an outpatient clinic, without hemodynamic decompensations, with excellent tolerance and without the requirement of hospital admissions.

Decanulación traqueal en pediatría: ¿cuándo y cómo? / Tracheal decannulation in pediatrics: When and how?

La decanulación es el proceso de retirar la cánula de traqueotomía de forma definitiva, una vez que la patología original que motivó la traqueotomía se haya resuelto o mejorado significativamente.La predicción del éxito de decanulación es difícil debido a la influencia de varios factores. No existe un protocolo universalmente aceptado. Existen diversos protocolos y la elección depende, en gran medida, de cada institución y de la situación individual de cada paciente. Sin embargo, para lograr la decanulación exitosa deben tenerse en cuenta varios criterios esenciales que deben cumplirse independientemente del protocolo elegido.Se señalan las características que debe reunir el paciente apto para la decanulación y se presentan recomendaciones sobre los pasos necesarios para lograr el retiro de la cánula de traqueotomía en el niño de manera segura y minimizando el riesgo de fracaso.

Decannulation is the process of removing the tracheotomy cannula permanently, once the original pathology that led to the tracheotomy has been resolved or significantly improved. The prediction of decannulation success is difficult due to the influence of several factors. There is no universally accepted decannulation protocol. There are several protocols and the choice depends, largely, on each institution and the individual situation of each patient. However, in order to achieve successful decannulation, several essential criteria must be taken into account, which must be fulfilled regardless of the chosen protocol.We indicate the characteristics that the patient must meet for decannulation, and we present recommendations on the necessary steps to achieve the removal of the tracheotomy cannula in a child safely and minimizing the risk of failure.

Manejo fonoaudiológico do paciente traqueostomizado no contexto da Covid-19: uma revisão do conhecimento atual / Speech therapy management of the tracheostomized patient in the context of Covid-19: a review of current knowledge / Manejo fonoaudiológico del paciente traqueostomizado en el contexto del Covid-19: una revisión de los conocimientos actuales

Introdução: O SARS-CoV-2 se estabeleceu como um dos principais agentes etiológicos de instabilidade da função pulmonar e repercussões no trato respiratório. Devido à necessidade de suporte ventilatório prolongado, pode ser observado aumento na demanda da indicação da traqueostomia. Objetivo: verificar as evidências disponíveis sobre o manejo fonoaudiológico da traqueostomia em pacientes com COVID-19, através de uma revisão breve do conhecimento atual. Método: As buscas foram realizadas nas bases de dados do Pubmed, Lilacs, Scielo, Web of Science, Scopus e Google Scholar, no período de agosto de 2020, através dos descritores "tracheostomy and COVID-19", extraídos do Medical Subject Headings (MeSH) e dos Descritores em Ciências da Saúde (DeCS). Resultados: seis estudos foram selecionados, de acordo com os critérios de elegibilidade. O processo de desmame do cuff ou troca da cânula da traqueostomia foi sugerido após resultado negativo para COVID-19. Os estudos sugerem avaliação clínica da deglutição, o uso de cânulas sem fenestra, com cuff insuflado. O uso de equipamentos de proteção individual foi fortemente indicado durante os procedimentos. Não há consenso quanto à intervenção fonoaudiológica para pacientes traqueostomizados com COVID-19. Conclusão: Esta revisão não mostrou evidências científicas sobre o manejo fonoaudiológico da traqueostomia em pacientes com COVID-19.

Introduction: SARS-CoV-2 has established itself as one of the main etiological agents of instability of pulmonary function and repercussions in the respiratory tract. Due to the need for prolonged ventilatory support, an increased demand for tracheostomy indication. Objective: to verify the available evidence on the speech therapy management of tracheostomy in patients with COVID-19, through a brief review of current knowledge. Method: Searches were carried out in the databases of Pubmed, Lilacs, Scielo, Web of Science, Scopus and Google Scholar, in the period of August 2020, using the descriptors "tracheostomy and COVID-19", extracted from the Medical Subject Headings (MeSH) and Health Sciences Descriptors (DeCS). Results: six studies were selected, according to the eligibility criteria. The process of weaning the cuff or changing the tracheostomy cannula was suggested after a negative result for COVID-19. Studies suggest clinical evaluation of swallowing, the use of cannulas without fenestra, with inflated cuff. The use of personal protective equipment was strongly recommended during the procedures. There is no consensus regarding speech therapy for patients with tracheostomy with COVID-19. Conclusion:This review did not show any scientific evidence on the speech therapy management of tracheostomy in patients with COVID-19.

Introducción: El SARS-CoV-2 se ha consolidado como uno de los principales agentes etiológicos de inestabilidad de la función pulmonar y repercusiones en el tracto respiratorio. Debido a la necesidad de soporte ventilatorio prolongado, una mayor demanda de indicación de traqueotomia. Objetivo: verificar la evidencia disponible sobre el manejo logopédico de la traqueotomía en pacientes con COVID-19, a través de una breve revisión de los conocimientos actuales. Método: Se realizaron búsquedas en las bases de datos de Pubmed, Lilacs, Scielo, Web of Science, Scopus y Google Scholar, en el período de agosto de 2020, utilizando los descriptores "traqueotomía y COVID-19", extraídos de Medical Subject Headings ( MeSH) y Descriptores de Ciencias de la Salud (DeCS). Resultados: se seleccionaron seis estudios, según los criterios de elegibilidad. El proceso de destete del manguito o cambio de cánula de traqueotomía se sugirió después de un resultado negativo para COVID-19. Los estudios sugieren una evaluación clínica de la deglución, el uso de cánulas sin fenestra, con manguito inflado. Se recomienda encarecidamente el uso de equipo de protección personal durante los procedimientos. No existe consenso con respecto a la terapia del habla para pacientes con traqueotomía con COVID-19. Conclusión: Esta revisión no mostró evidencia científica sobre el manejo logopédico de la traqueotomía en pacientes con COVID-19.

Caracterización de las infecciones en niños portadores de cánula de traqueotomía: revisión sistemática de la literatura / Characterization of infections in children with Tracheostomy Tube: A Systematic Review of the Literature

Resumen Introducción: actualmente los profesionales de la salud se enfrentan al manejo de las vías aéreas artificiales en grupos pediátricos, esto requiere de cuidados delicados y mucha atención para detectar, establecer y manejar situaciones apremiantes; por esta razón, existe un mayor riesgo de aparición de infecciones bacterianas traqueopulmonares. El objetivo del estudio fue analizar la caracterización de las infecciones en pacientes pediátricos portadores de cánula de traqueotomía en las diferentes publicaciones científicas. Materiales y métodos: se realizó una revisión sistemática mediante la búsqueda de la literatura existente entre los años 2015-2020 en las bases de datos Elsevier, PubMed, Google Académico y SciELO, teniendo en cuenta los criterios de inclusión artículos en idioma inglés, español y población de edad entre los 0-15 años con infección de cánula de traqueotomía en los años 2015-2020. Resultados: de 258 artículos distribuidos en las bases de datos, se seleccionaron 21 artículos que cumplían con los criterios de inclusión. Conclusiones: a pesar de que en la actualidad existan criterios clínicos, factores de riesgo y pruebas de laboratorio asociados a infecciones de la cánula postraqueotomía en pacientes pediátricos, se requiere mayor investigación para definir las guías clínicas de manejo en la toma de decisiones médicas. Asimismo, se consideró como limitación importante la cantidad de literatura existente con respecto al tema.

Abstract Introduction: Currently, health professionals face the management of artificial airways in pediatric groups, this requires delicate care and a lot of attention to detect, establish and manage pressing situations, which is why there is a greater risk of tracheo-pulmonary bacterial infections. The objective was to analyze the characterization of infections in pediatric patients with tracheostomy tubes in the different scientific publications. Method: A systematic review of the literature was carried out between the years 2015-2020 in Elsevier, PubMed, Google Academic and SciELO databases, taking into account the inclusion criteria of the population aged 0-15 years in the years 2015-2020. The amount of existing literature on the subject was considered an important limitation. Results: From 258 articles distributed in the databases, 21 articles were selected that met the inclusion criteria. Conclusions: Although there are currently clinical criteria, risk factors and laboratory tests associated with infections of the post-tracheotomy tube in pediatric patients, further research is required to define clinical guidelines for management in medical decision-making.