Unplanned tracheostomy following pediatric cardiac surgery

To identify factors contributing to unplanned tracheostomy following cardiac surgery in children under 12 months without prior airway support.

Case series with chart review.

Eleven patients were identified (eight male, three female). Eight were term, three preterm. Four had syndromes associated with cardiac disease. Age at cardiac surgery was 2.2 (0.1-5.2) months. Time between surgery and tracheostomy was 1.2 (0-3) months. Two groups were identified. The first had tracheobronchomalacia as the primary diagnosis (n = 9). Time post-surgery for tracheostomy was 1.2 (0.5-3) months. The second had bilateral vocal fold paralysis (n = 2). Both children had cardiac procedures that have recognized risk to the left recurrent laryngeal nerve (RLN). Both had cannulation of the right internal jugular vein at the time of surgery. Tracheostomy occurred within three days of the cardiac procedure.

Investigations for tracheobronchomalacia should occur if a child continues to fail ventilator weaning or extubation following cardiac surgery. Risk of right RLN injury due to right vascular instrumentation should be minimized in left RLN prone procedures.