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Tracheostomy in children
Insights
The flap technique for pediatric tracheostomies is safe, with a 19% complication rate including deaths. Long-term follow-up showed minimal issues, indicating the procedure
Area of Science:
- Pediatric Surgery
- Otolaryngology
- Respiratory Medicine
Background:
- Tracheostomy is a common procedure in children requiring airway management.
- The flap technique is one method used for creating a tracheostomy.
- Assessing the safety and long-term outcomes of this technique in pediatric patients is crucial.
Purpose of the Study:
- To evaluate the safety and complication rates of the flap technique in pediatric tracheostomies.
- To assess the long-term outcomes and potential sequelae after decannulation.
Main Methods:
- Retrospective review of 47 pediatric patients who underwent tracheostomy using the flap technique.
- Analysis of immediate complications, mortality, and decannulation difficulties.
- Long-term clinical reexamination and tracheography in 20 patients (4-10 year follow-up).
Main Results:
- Overall mortality was 32% (28% from underlying disease, 4% from tracheostomy complications).
- Primary complication rate was 19%, including 2 deaths, difficult decannulation in 4 patients, and individual cases of bleeding, infection, and tracheocutaneous fistula.
- Long-term follow-up revealed minimal tracheal stenosis (1 case) and slight wall depressions (2 cases).
Conclusions:
- The flap technique for pediatric tracheostomy demonstrates an acceptable safety profile when performed correctly.
- While immediate complications can occur, long-term sequelae appear to be infrequent and minor.
- The flap technique is a viable and safe option for pediatric tracheostomies.
Abstract:
Tracheostomies were performed on 47 children, using the flap technique. Thirteen patients (28%) died of their basic disease and two (4%) died of complications resulting from the tracheostomy. Decannulation was difficult in four patients, and there was one case each of bleeding, infection, and tracheocutaneous fistula. Thus, the primary complication rate was 19%, including the two deaths. Clinical reexamination with tracheography was made on 20 patients after a follow-up period varying from four to ten years (average, eight years). One small stenotic ring in the area of the distal end of the cannula site and two slight depressions in the tracheal forewall were found. According to these results, the flap technique, if properly performed, is safe also in children.