RESPIRATORY IMPAIRMENT IN PATIENTS WITH HYPOXIC- ISCHEMIC ENCEPHALOPATHY: THE APPLICATION OF TRACHEOSTOMY AND TRACHEOESOPHAGEAL DIVERSION LOPATHY

Objectives: The patients with hypoxic ischemic encephalopathy (HIE) have various neurological symptoms such as mental retardation, motor impairment, and epilepsy. Consequently those symptoms cause various physical impairments. Aspiration by dysphagia and abnormal muscle tonus cause respiratory impairment, which is lifethreatening complication and very important to treat. To solve the severe respiratory problem, tracheostomy and tracheoesophageal diversion are applied to some patients who don't show any improvement from medication and physical therapy. To determine the indication for those operations, we investigated the background of the patients undergoing those operations, the effects and complications.

Methods: Patients: 25 patients with HIE who underwent tracheostomy or tracheosophageal diversion were reviewed. (mean age 19.4 years; range 3 to 39 years). We investigated neurological and physical impairments, the reason of operation and outcomes.

Results: Medical background: All patients could neither sit alone nor speak. All patients had swallowing difficulty. 20 of them took muscle relaxants for severe spasticity. 18 patients had gastroesophageal reflux (GER). 4 patients underwent tracheostomy, 21patients tracheoesophageal diversion. The time of operation is 13.2 years on average (6 months to 35 years). Reasons of the operation: 1)Tracheostomy; 3 patients for long term use of ventilator, one patient for airway obstruction 2) Tracheoesophageal diversion; 21 patients for recurrent aspiration pneumonia, 13 for airway obstruction caused by spasticity of neck muscles Effect: The incidence of pneumoniae decreased and improved respiratory function in all patients. In 2 of 18 patients with GER, the symptoms, such as vomiting, improved.2 of patients with diversion could eat safely. Complications: One patient suffered from hypoxic brain damage because of the obstruction of cannula caused by neck spasticity. One patient had granulation of trachea.

Conclusion: Tracheostomy and tracheoesophageal diversion improve respiratory function and another complication. However, they accompany serious complications in some cases. Careful management and treatment, especially for spasticity, are necessary.