INTRODUCTION: Tracheostomy is a lifesaving intervention with numerous complications. OBJECTIVES: We describe the natural history of tracheostomy in children in a defined geographical area over a 17-year period. Our primary aim is to stress the need for a consensus on pediatric tracheostomy care. METHODS: This retrospective study reviewed the charts of 72 children who had tracheostomy between January 1990 and January 2007. Indications for the procedure were divided into 3 groups: (1) upper airway obstruction at a well-defined anatomic site (32 patients); (2) upper airway obstruction with a complex medical condition (24 patients); and (3) need for an access to the lower airway for long-term ventilation and pulmonary care with normal airway anatomy (16 patients). RESULTS: The most common indication for tracheostomy was upper airway obstruction due to subglottic stenosis (15 patients, 21%) or as part of a complex craniofacial syndrome (15 patients, 21%). The duration of intubation prior to tracheostomy and the duration of hospitalization after tracheostomy varied markedly. Tracheocutaneous fistulae complicated 15 of the 38 (37%) decannulated patients. Tracheostomy infection occurred in 90% of the patients and tracheal granulation in 56%. Eleven (15%) deaths occurred, 10 were due to the underlying medical illness and 1 to a mucous plug. CONCLUSION: The complications of tracheostomy in children are substantial. Surveillance and prompt interventions are necessary to overcome life-threatening sequelae. A multidisciplinary (medical-surgical) approach provides better care for these highly vulnerable children. A consensus on pediatric tracheostomy care is needed.
INTRODUCTION: Tracheostomy is a lifesaving intervention with numerous complications. OBJECTIVES: We describe the natural history of tracheostomy in children in a defined geographical area over a 17-year period. Our primary aim is to stress the need for a consensus on pediatric tracheostomy care. METHODS: This retrospective study reviewed the charts of 72 children who had tracheostomy between January 1990 and January 2007. Indications for the procedure were divided into 3 groups: (1) upper airway obstruction at a well-defined anatomic site (32 patients); (2) upper airway obstruction with a complex medical condition (24 patients); and (3) need for an access to the lower airway for long-term ventilation and pulmonary care with normal airway anatomy (16 patients). RESULTS: The most common indication for tracheostomy was upper airway obstruction due to subglottic stenosis (15 patients, 21%) or as part of a complex craniofacial syndrome (15 patients, 21%). The duration of intubation prior to tracheostomy and the duration of hospitalization after tracheostomy varied markedly. Tracheocutaneous fistulae complicated 15 of the 38 (37%) decannulated patients. Tracheostomy infection occurred in 90% of the patients and tracheal granulation in 56%. Eleven (15%) deaths occurred, 10 were due to the underlying medical illness and 1 to a mucous plug. CONCLUSION: The complications of tracheostomy in children are substantial. Surveillance and prompt interventions are necessary to overcome life-threatening sequelae. A multidisciplinary (medical-surgical) approach provides better care for these highly vulnerable children. A consensus on pediatric tracheostomy care is needed.
Authors: Mana Espahbodi; Samantha Kallenbach; Chiang-Ching Huang; Robert H Chun; Michael E McCormick Journal: Int J Pediatr Otorhinolaryngol Date: 2020-03-31 Impact factor: 1.675
Authors: Amanda K Morrow; David E Tunkel; Joseph M Collaco; Sharon A McGrath-Morrow; Janet C Lam; Jennifer A Accardo; Suzanne V Rybczynski Journal: Pediatr Pulmonol Date: 2018-12-11
Authors: A Ioana Cristea; Aaron E Carroll; Stephanie D Davis; Nancy L Swigonski; Veda L Ackerman Journal: Pediatrics Date: 2013-08-05 Impact factor: 7.124
Authors: Deborah R Liptzin; Elisabeth A Connell; Jennifer Marable; Jill Marks; Jodi Thrasher; Christopher D Baker Journal: Pediatr Pulmonol Date: 2016-04-25