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Indications for tracheostomy in children.

Daniel Trachsel1, Jürg Hammer

  • 1Division of Paediatric Intensive Care and Pulmonology, University Children's Hospital Basel, Römergasse 8, CH-4059 Basel, Switzerland. daniel.trachsel@ukbb.ch

Paediatric Respiratory Reviews
|August 30, 2006
PubMed
Summary

Emergency tracheostomies for acute upper airway obstruction are now rare due to medical advancements. Current indications for pediatric tracheostomy involve anticipated long-term respiratory compromise or severe airway obstruction, often requiring multidisciplinary ethical and socio-economic considerations.

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Area of Science:

  • Pediatric critical care medicine
  • Otolaryngology
  • Respiratory medicine

Background:

  • Medical advancements including vaccination programs, material engineering, and anesthesia have significantly decreased emergency tracheostomies for acute upper airway obstruction.
  • Current indications for tracheostomy in children primarily involve anticipated long-term cardiorespiratory compromise from chronic ventilatory or cardiac insufficiency, or fixed, non-resolving upper airway obstruction.

Purpose of the Study:

  • To review the current indications and considerations for pediatric tracheostomy.
  • To highlight the complexities and evolving alternatives in managing pediatric airway obstruction.

Main Methods:

  • Review of current clinical practice and literature regarding pediatric tracheostomy.
  • Discussion of non-invasive ventilation and alternative devices.

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Main Results:

  • Tracheostomy is now indicated for chronic conditions rather than acute emergencies.
  • Complex pediatric cases necessitate a multidisciplinary approach addressing ethical, funding, and socio-economic factors.
  • Non-invasive ventilation and devices like the in-exsufflator are emerging alternatives.

Conclusions:

  • Pediatric tracheostomy indications have shifted towards managing chronic respiratory insufficiency and severe airway obstruction.
  • A comprehensive, multidisciplinary approach is crucial for managing complex pediatric cases, considering ethical and socio-economic factors.
  • Non-invasive ventilation strategies offer promising alternatives to tracheostomy in select pediatric patients.