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Tracheostomy in children: a population-based experience over 17 years

Mohammed Al-Samri1, Ian Mitchell, Derek S Drummond

  • 1Faculty of Medicine and Health Sciences, Department of Pediatrics, United Arab Emirates University, Al-Ain, United Arab Emirates.

Pediatric Pulmonology
|April 29, 2010
PubMed

Insights

Pediatric tracheostomy is lifesaving but has serious complications, including high rates of infection and granulation. A consensus on care is urgently needed for these vulnerable children.

Area of Science:

  • Pediatric Surgery
  • Otolaryngology
  • Critical Care Medicine

Background:

  • Tracheostomy is a critical intervention for children facing airway obstruction or requiring prolonged ventilation.
  • Despite its life-saving role, pediatric tracheostomy is associated with significant and varied complications.
  • Understanding the natural history of tracheostomy in children is essential for improving patient outcomes.

Purpose of the Study:

  • To describe the natural history of pediatric tracheostomy over a 17-year period in a defined region.
  • To highlight the substantial complications associated with pediatric tracheostomy.
  • To emphasize the critical need for a standardized consensus on pediatric tracheostomy care.

Main Methods:

  • A retrospective chart review of 72 children who underwent tracheostomy between January 1990 and January 2007.
  • Categorization of indications into upper airway obstruction (isolated or complex) and need for long-term ventilation.
  • Analysis of procedure indications, duration of intubation/hospitalization, and complication rates.

Main Results:

  • Upper airway obstruction, particularly subglottic stenosis and craniofacial syndromes, were the most common indications (21% each).
  • High complication rates were observed, including tracheostomy infection (90%), tracheal granulation (56%), and tracheocutaneous fistulae (37% in decannulated patients).
  • Eleven deaths (15%) occurred, primarily due to underlying medical conditions.

Conclusions:

  • Pediatric tracheostomy is associated with substantial morbidity and mortality.
  • Continuous surveillance and prompt interventions are crucial to manage life-threatening sequelae.
  • A multidisciplinary, medical-surgical approach and a consensus on care protocols are vital for optimizing outcomes in pediatric tracheostomy patients.
Abstract

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