Pediatric tracheotomy: the Universitair Ziekenhuis Brussels' experience

To investigate indications, features and outcome of pediatric tracheotomy in our ENT department.

A retrospective chart review of all pediatric patients who underwent tracheotomy between 1992 and 2006 in the Children's Hospital of the Universitair Ziekenhuis Brussel. The main parameters of the study were age, gender, indications, morbidity and mortality rate, time and success of decannulation.

Twenty-nine children younger than 16 years of age, 21 males and 8 females, underwent tracheotomy. Indications for tracheotomy fell into two main groups: chronic diseases requiring ventilation support (55%) and relief of airway obstruction (45%). Tracheotomies were mainly performed in young children, 76% were under 3 years of age. In this age group, upper airway obstruction was the most frequent indication. The complication rate was 36%, and the nontracheotomy-related mortality rate was 25%. The tracheotomy-related mortality rate was 3.5%. Successful decannulation was possible in 28% after a mean duration of 24 months after surgery. Of the remaining 72% for whom decannulation was not performed, 35% died mainly because of the underlying disease. Those infants failing decannulation (65%) had neurologic disorders.

In accord with the literature, where a shift towards very young patients and towards indications related to chronic ventilatory support is observed, in this series tracheotomies were mainly performed for the youngest children. Relief of upper airway obstruction was the most frequent indication. Morbidity and mortality rates among this specific patient population should not be ignored.