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

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.