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Paediatric tracheostomy: Sheffield experience 1979-1999
Katie I Midwinter1, Sean Carrie, Peter D Bull
1Department of Otolaryngology, Hallamshire Hospital, Sheffield, UK.
Insights
This study reviewed 148 pediatric tracheostomies, finding acquired subglottic stenosis a common cause. Complications occurred in 46%, with four tracheostomy-related deaths, but most children were successfully decannulated.
Area of Science:
- Pediatric Surgery
- Otolaryngology
- Critical Care Medicine
Background:
- Tracheostomy is a vital procedure in pediatric care.
- Understanding long-term outcomes and complications is crucial for improving patient management.
Purpose of the Study:
- To review the experience and outcomes of tracheostomies performed over 20 years at a children's hospital.
- To identify indications, complications, and decannulation rates in pediatric patients.
Main Methods:
- Retrospective review of 148 tracheostomies in 143 children (aged 1 day to 13 years).
- Analysis of indications, complications, mortality, and decannulation data.
Main Results:
- 65% of patients were under one year old.
- Indications included upper airway obstruction (72%) and assisted ventilation (28%).
- Acquired subglottic stenosis was the most common indication (25%).
- Complication rate was 46%, with granulation tissue most frequent.
- Four deaths were directly related to tracheostomy (accidental decannulation, obstruction).
- 89 children were decannulated, with an average time of 25 months.
Conclusions:
- Tracheostomy in children is associated with significant complication rates.
- Acquired subglottic stenosis is a primary indication in infants.
- Careful management and monitoring are essential for successful decannulation and minimizing mortality.
Abstract:
We have reviewed our experience of tracheostomy in children over the past 20 years at Sheffield Children's Hospital. One hundred and forty-eight tracheostomies were performed in 143 children aged one day to 13 years old (average 27 months). Sixty-five per cent of patients were < one year old. The indications for tracheostomy were upper airways' obstruction in 72 per cent, and assisted ventilation/ bronchopulmonary toilet in 28 per cent. The commonest single reason was acquired subglottic stenosis (SGS) in infants, accounting for 25 per cent of tracheostomies (36/143). The complication rate of tracheostomy was 46 per cent, most commonly granulation tissue formation. There were four deaths directly due to the tracheostomy: two accidental decannulations and two obstructions. Eighty-nine children were decannulated under our care. The average time until decannulation was 25 months.