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Pediatric tracheotomy: A comparison of outcomes and lengths of hospitalization between different indications
Che-Yi Lin1, Te-Tien Ting2, Tzu-Yu Hsiao3
1Department of Otolaryngology, National Taiwan University, College of Medicine and National Taiwan University Hospital, Taipei, Taiwan; Department of Otolaryngology, National Taiwan University Hospital, Yunlin Branch, Yunlin, Taiwan.
Insights
Pediatric tracheotomy outcomes and hospital stay vary by indication. Conditions like craniofacial anomalies lead to longer hospitalizations, while earlier tracheotomy can reduce ventilation duration.
Area of Science:
- Pediatric Surgery
- Otolaryngology
- Critical Care Medicine
Background:
- Tracheotomy is a crucial intervention for pediatric airway management.
- Understanding the impact of indications on outcomes is vital for optimizing patient care.
Purpose of the Study:
- To evaluate the outcomes of pediatric tracheotomy.
- To assess the length of hospital stay based on tracheotomy indications.
Main Methods:
- Retrospective analysis of 142 pediatric patients (<18 years) undergoing tracheotomy.
- Data collected included indications, pre-operative status, and post-operative outcomes (weaning, hospital stay, mortality).
Main Results:
- Indications varied: neurological deficit (40.8%), upper airway obstruction (28.9%), craniofacial anomalies (13.4%), prolonged ventilation (10.6%), and trauma (6.3%).
- Patients with craniofacial anomalies experienced the longest hospital stays and pre-tracheotomy ventilation durations.
- Early tracheotomy was associated with shorter post-operative mechanical ventilation durations.
Conclusions:
- Pediatric tracheotomy outcomes and hospitalization duration are indication-dependent.
- Craniofacial anomalies correlate with prolonged ventilation and hospitalization.
- Timely tracheotomy can improve post-operative ventilation outcomes.
Objectives:
To assess outcomes of pediatric tracheotomy and duration of associated hospital stay according to indications.
Subjects And Methods:
In this retrospective study, subjects were 142 consecutive pediatric patients (<18 years old) who underwent tracheotomy at a tertiary referral medical center, National Taiwan University Hospital, in 1997-2012. Age, sex, indications, pre-operative status (oxygen demand, number of repeated intubations), and post-operative status (duration of weaning, length of hospital stay, mortality) were analyzed.
Results:
The indications included craniofacial anomalies (n = 19, 13.4%), upper airway obstruction (n = 41, 28.9%), neurological deficit (n = 58, 40.8%), prolonged ventilation (n = 15, 10.6%), and trauma (n = 9, 6.3%). Ninety-one patients (64.1%) were successfully weaned off ventilation after tracheotomy (40% in the prolonged ventilation group). Total hospital stay and duration of ventilation before tracheotomy were longest in patients with craniofacial anomalies (150.9 ± 98.8 days, p = 0.004; 108.8 ± 88.2, p < 0.001). The early tracheotomy group had a shorter duration of post-tracheotomy mechanical ventilation support than the late tracheotomy group (14.4 ± 19.0, n = 49 vs. 34.9 ± 58.6, n = 80, p = 0.004). Decannulation was successful in 20 patients (14.1%), with the highest rate in the upper airway obstruction group (n = 14, 34.1%) and lowest in the prolonged ventilation group (none). Thirteen patients (9.2%) died during admission from causes unrelated to tracheotomy.
Conclusion:
Outcomes of pediatric tracheotomy and duration of hospitalization depend on indications. Children with craniofacial anomalies had earlier tracheotomy age and longer mechanical ventilation before tracheotomy resulted in longer hospitalization. Earlier tracheotomy can shorten the duration of post-tracheotomy mechanical ventilation in several conditions.
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