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Tracheostomy in children: there is a place for acceptable risk
E P Rocha1, M D Dias, F E Szajmbok
1Emergency Surgery Department ICU, Hospital das Clinicas, University of Sao Paulo School of Medicine, Sao Paulo, Brazil.
Insights
Tracheostomy in children with severe head injuries is generally safe. Most complications observed were linked to prolonged intubation, not the tracheostomy procedure itself, suggesting it
Area of Science:
- Pediatric Critical Care Medicine
- Otolaryngology
- Trauma Surgery
Background:
- Tracheostomy in pediatric patients is a debated procedure due to potential complications.
- Severe head injury in children often necessitates prolonged mechanical ventilation.
Purpose of the Study:
- To evaluate the safety and complication profile of tracheostomy in pediatric trauma patients with severe head injuries.
- To determine if tracheostomy-related complications outweigh the benefits in this specific patient group.
Main Methods:
- Retrospective analysis of 46 pediatric trauma patients with severe head injury and coma.
- Tracheostomy performed after an average of 5.9 days of endotracheal intubation.
- Follow-up assessment including clinical evaluation and endoscopy.
Main Results:
- No deaths directly attributed to tracheostomy; six deaths resulted from severe head injury.
- Most post-tracheostomy complications (subglottic granulomas/stenosis) were associated with prior intubation.
- Long-term follow-up indicated a low incidence of significant tracheal stenosis directly from tracheostomy.
Conclusions:
- Tracheostomy is a viable and relatively safe intervention for pediatric patients with severe head injuries requiring extended ventilatory support.
- Complications are more frequently linked to the duration of endotracheal intubation than the tracheostomy procedure.
- The benefits of tracheostomy in facilitating weaning from mechanical ventilation in this population appear to outweigh the risks.
Background:
Tracheostomy in children remains controversial regarding the risk of complications.
Methods:
Forty-six trauma patients (35 male and 11 female, mean age = 6.8 years) were admitted to the intensive care unit between 1987 and 1991 with severe head injury plus coma. Tracheostomy was performed with standard technique after 5.9 days (range, 2-12 days) of intubation.
Results:
There were no deaths from tracheostomy, but six deaths resulted from severe head injury. One child was discharged with tracheostomy. The 39 survivors remained with tracheostomy 16.14 days (range, 4-71 days) in the intensive care unit. After cannula removal, 31 remained asymptomatic; 8 had respiratory distress: 2 were normal, 5 had endoscopic treatment for subglottic granulomas/stenosis from intubation, and 1 had tracheomalacia from tracheostomy. In 1997, the 18 patients located for follow-up were asymptomatic. At endoscopy, 8 were normal, 9 had subglottal granulomas from intubation, and 1 had 20% tracheal stenosis from tracheostomy.
Conclusion:
Most complications after tracheostomy result from intubation. Tracheostomy has an acceptable risk in children with severe head injury who need prolonged ventilatory support.