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Published on: December 5, 2025

The influence of peak airway pressure and oxygen requirement on infant tracheostomy

James W Schroeder1, John S Schneider, David L Walner

  • 1Children's Memorial Hospital, Northwestern University Department of Otolaryngology, Chicago, IL 60614, USA. jschroeder@childrensmemorial.org

International Journal of Pediatric Otorhinolaryngology
|March 27, 2012
PubMed

Insights

Physician decisions regarding infant tracheostomy are not swayed by peak airway pressure or oxygen needs. However, high peak airway pressure does influence the choice of a cuffed tracheostomy tube in infants.

Area of Science:

  • Pediatric Otolaryngology
  • Respiratory Medicine
  • Surgical Decision-Making

Background:

  • Infants requiring mechanical ventilation present complex management challenges.
  • Tracheostomy is a critical intervention for prolonged airway support in neonates and infants.
  • Understanding factors influencing tracheostomy decisions is vital for optimizing patient outcomes.

Purpose of the Study:

  • To investigate whether preoperative peak airway pressure (PAP) and oxygen requirements impact pediatric otolaryngologists' decisions to perform tracheostomies in infants (<6 months).
  • To assess the influence of these preoperative parameters on the selection of tracheostomy tube type (cuffed vs. uncuffed).

Main Methods:

  • A nationwide web-based survey was distributed to members of the American Society of Pediatric Otolaryngology.
  • The survey queried physicians' practices and decision-making processes regarding tracheostomy in infants with specific preoperative respiratory parameters.
  • Response rate was 43% (150 out of 348 surveys returned).

Main Results:

  • The majority of surveyed otolaryngologists (54.7% for PAP, 72.1% for oxygen) do not view elevated preoperative peak airway pressure or high oxygen requirements as contraindications for infant tracheostomy.
  • A significant proportion of respondents (68.2%) reported that high preoperative PAP influences their decision to use a cuffed tracheostomy tube.
  • Postoperative mucous plugging was identified as the most common cause of morbidity/mortality, often attributed to preoperative pulmonary comorbidities.

Conclusions:

  • Preoperative peak airway pressure and oxygen needs do not significantly influence the decision to perform a tracheostomy in infants.
  • Peak airway pressure is a key factor considered when selecting between cuffed and uncuffed tracheostomy tubes for pediatric patients.
  • Pulmonary comorbidities are recognized as a major contributor to postoperative complications following tracheostomy in infants.
Abstract

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