Tracheostomy in Infants and Children

Area of Science:

• Pediatric critical care medicine
• Otolaryngology
• Respiratory medicine

Background:

• Tracheostomy is increasingly performed in pediatric intensive care units (ICUs), often for complex patients requiring long-term support.
• While common in adult ICUs, tracheostomy is less frequent in pediatric ICUs (<3% of patients).
• Current practice lacks consensus on optimal timing for tracheostomy after endotracheal intubation and on decannulation protocols.

Purpose of the Study:

• To review indications, preoperative considerations, and procedure types for pediatric tracheostomy.
• To present an ideal decannulation protocol and review existing algorithms.
• To highlight the need for improved care coordination and quality improvement initiatives for pediatric tracheostomy.

Main Methods:

• Literature review of pediatric tracheostomy practices.
• Analysis of current consensus and guidelines.
• Review of quality improvement initiatives, including the Global Tracheostomy Collaborative.

Main Results:

• Pediatric tracheostomy is predominantly a surgical procedure, with percutaneous methods used infrequently.
• Adverse events and mortality in children with tracheostomy are often linked to comorbidities, not the tracheostomy itself.
• Many tracheostomy-related events are preventable with improved care coordination.

Conclusions:

• A multidisciplinary, coordinated approach to pediatric tracheostomy care is essential for improving outcomes.
• Standardized decannulation protocols are needed to optimize patient management.
• Quality improvement initiatives are crucial for enhancing the safety and effectiveness of pediatric tracheostomy care.