Early and long-term outcome after tracheostomy in children

Tracheostomy has become an increasingly important issue for children discharged with primary or secondary respiratory problems. Despite the known advantages, considerable controversy remains regarding the appropriate indications, timing, and results of tracheostomy, in the context of home care. The aims of this study were to retrospectively evaluate our experience with tracheostomy and to consider problems related to this procedure, both in the hospital and after discharge.

We performed a retrospective chart review of all patients receiving new tracheostomies in our department, over a 5-year period.

Thirty tracheostomies were performed in 30 patients over a 5-year period. The overall tracheostomy rate among ventilated patients was 3.4%. Most (90%) of the tracheostomies were placed after mechanical ventilation. Patients who were successfully decannulated spent significantly less time in intensive care, both before (P= 0.01) and after surgical tracheostomy procedure (P= 0.034) when compared to the patients discharged with tracheostomy, either with or without home ventilation. These patients also had shorter total intensive care admissions (P= 0.002) and shorter hospitalizations overall (P= 0.013). Successful decannulation was achieved in five patients (17%). The cumulative mortality rate was 17% in the pediatric intensive care unit, 20% within 30 days, and 41% within 1 year.

Patients admitted with anatomic or functional airway problems had higher decannulation rates. Patients who were successfully decannulated also had significantly shorter PICU stays prior to tracheostomy. In patients with neurologic and muscular disease, or with chronic heart/lung disease, decannulation rates are very low, and these patients have a higher mortality risk after discharge.