Clinical characteristics and gaps in palliative care among tracheostomized children: a retrospective observational study

IF 3 4区医学 Q1 PEDIATRICS

Jornal de pediatria Pub Date : 2026-01-01 Epub Date: 2025-12-12 DOI:10.1016/j.jped.2025.101480

Luziane Lais Sabino Silva Luna, Sheyla Suelle dos Santos Levy, Luciana Santana Lima, Maria do Carmo Menezes Bezerra Duarte

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引用次数: 0

Abstract

Objective

To describe the clinical characteristics of tracheostomized children in Northeastern Brazil and to identify existing gaps in the indication and implementation of palliative care.

Methods

This retrospective descriptive study reviewed medical records of children under 15 years who underwent tracheostomy between 2008 and 2019 at a quaternary referral center.

Results

Sixty-five tracheostomized patients with indications for palliative care were analyzed. The main reasons for palliative classification were acute life-threatening conditions (50.7 %) and chronic life-threatening conditions (20 %). The most frequent tracheostomy indications were prolonged invasive mechanical ventilation (46.1 %) and severe upper airway obstruction (23 %). The mortality rate was 30.7 %, higher among infants, severely malnourished children, those with Lansky scores below 40 % before tracheostomy, congenital heart disease, bronchopulmonary dysplasia, and multiple comorbidities. Only 10.8 % received palliative care consultations during hospitalization, all in the end-of-life care phase.

Conclusions

The results highlight a critical gap in the provision of palliative care to tracheostomized children. Early involvement of a multidisciplinary palliative care team is crucial to support clinical decision-making, family-centered care, and ensure quality of life. The proposed framework may facilitate timely referral and airway planning in the Intensive therapy, although further validation and qualitative research in various healthcare settings are needed.

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气管造口术患儿姑息治疗的临床特点和差距：一项回顾性观察研究。

目的：描述巴西东北部气管造口手术儿童的临床特征，并确定姑息治疗的指征和实施方面存在的差距。方法：本回顾性描述性研究回顾了2008年至2019年在一家四级转诊中心接受气管切开术的15岁以下儿童的医疗记录。结果：分析了65例气管造口术患者的姑息治疗指征。姑息分类的主要原因是急性危及生命（50.7%）和慢性危及生命（20%）。最常见的气管造口指征是长时间有创机械通气（46.1%）和严重上气道阻塞（23%）。死亡率为30.7%，其中婴儿、严重营养不良儿童、气管切开术前Lansky评分低于40%的儿童、先天性心脏病、支气管肺发育不良和多种合并症的死亡率更高。只有10.8%的人在住院期间接受了姑息治疗咨询，所有这些都是在临终关怀阶段。结论：该结果突出了在气管造口术儿童姑息治疗方面的关键差距。多学科姑息治疗团队的早期参与对于支持临床决策、以家庭为中心的护理和确保生活质量至关重要。尽管需要在各种医疗保健环境中进一步验证和定性研究，但所提出的框架可能有助于在强化治疗中及时转诊和气道规划。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Jornal de pediatria 医学-小儿科

CiteScore

5.60

自引率

3.00%

发文量

审稿时长

43 days

期刊介绍： Jornal de Pediatria is a bimonthly publication of the Brazilian Society of Pediatrics (Sociedade Brasileira de Pediatria, SBP). It has been published without interruption since 1934. Jornal de Pediatria publishes original articles and review articles covering various areas in the field of pediatrics. By publishing relevant scientific contributions, Jornal de Pediatria aims at improving the standards of pediatrics and of the healthcare provided for children and adolescents in general, as well to foster debate about health.