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Tracheostomy
N J Freezer1, S W Beasley, C F Robertson
1Department of Thoracic Medicine, Royal Children's Hospital, Parkville, Victoria, Australia.
Insights
Pediatric tracheostomy is well tolerated with few complications, even when managed at home by families. This study reviewed 142 children, finding safe home management and low mortality rates for tracheostomy patients.
Area of Science:
- Pediatric Surgery
- Otolaryngology
- Respiratory Medicine
Background:
- Tracheostomy is a critical intervention for pediatric airway management.
- Understanding long-term outcomes and complications is essential for patient care.
Purpose of the Study:
- To evaluate the safety, efficacy, and outcomes of tracheostomy in a pediatric population.
- To identify common indications and complications associated with pediatric tracheostomy.
Main Methods:
- Retrospective review of medical records for all children undergoing tracheostomy between January 1979 and December 1988.
- Data collection included patient demographics, indications for tracheostomy, duration of tube placement, complications, and outcomes.
Main Results:
- 142 pediatric patients received tracheostomy, with 70 in the first year of life.
- Common indications included trauma, acquired subglottic stenosis, and congenital syndromes.
- 60% of patients were discharged with tracheostomy in situ; no home-related deaths occurred. Complications included granulomas and fistulas.
Conclusions:
- Pediatric tracheostomy is generally well-tolerated with a low complication rate.
- Home management by families is feasible and safe, with no reported home-related deaths.
- Tracheostomy can be safely managed in the home setting by families, with appropriate support.
Abstract:
The records of all children who had a tracheostomy performed over a 10 year period from January 1979 were reviewed. Altogether 142 patients aged 1 day to 24.8 years received a tracheostomy, 70 in the first year of life. The conditions necessitating tracheostomy were trauma (n = 21), acquired subglottic stenosis (n = 21), subglottic haemangioma (n = 16), Guillain-Barré syndrome (n = 14), Pierre Robin syndrome (n = 9), craniofacial disorders (n = 9), micrognathia (n = 5), and others in 47. In patients successfully decannulated the median period of tracheostomy was 104 days (range 3 days to 9.0 years) and in 25 patients the tracheostomy is still in situ. Eighty four patients (60%) were discharged from hospital with their tracheostomy in situ and no patient was kept in hospital because of a tracheostomy beyond four weeks. There were two tracheostomy related deaths in hospital. Both patients had severe acquired subglottic stenosis secondary to ventilation for lung disease of prematurity. There were no tracheostomy related deaths at home; complications included tracheal granulomas and polyps (n = 19). After removal of the tracheostomy 13 children had a fistula requiring surgical closure and four required revision of the tracheostomy scar. Tracheostomy is well tolerated in small children, with few complications and can be managed safely in the home by the family.