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Pediatric tracheocutaneous fistula closure following tracheostomy decannulation

Benjamin L Wisniewski1, Emily L Jensen2, Jeremy D Prager2

  • 1Department of Pediatrics, Section of Pulmonary Medicine, The Ohio State University College of Medicine, Nationwide Children's Hospital, Columbus, Ohio, USA.

International Journal of Pediatric Otorhinolaryngology
|July 13, 2019
PubMed

Insights

Approximately 50% of pediatric tracheostomy stoma sites close spontaneously. Persistent tracheocutaneous fistula (TCF) development is linked to younger age at placement, longer tracheostomy duration, and tracheobronchomalacia.

Area of Science:

  • Pediatric Surgery
  • Otolaryngology
  • Pulmonology

Background:

  • Tracheostomy decannulation in children can lead to persistent tracheocutaneous fistula (TCF).
  • Understanding TCF development is crucial for managing pediatric airway issues.

Purpose of the Study:

  • To determine the frequency and risk factors for persistent TCF after pediatric tracheostomy decannulation.
  • To identify predictors of spontaneous versus surgical TCF closure.

Main Methods:

  • Retrospective chart review of 129 pediatric patients undergoing tracheostomy decannulation (2007-2013).
  • TCF defined as a persistent fistula six months post-decannulation.
  • Analysis of demographics, tracheostomy details, comorbidities, and closure methods.

Main Results:

  • 49% of patients required surgical closure of TCF.
  • Surgical closure associated with younger age at tracheostomy, longer tracheostomy duration, and tracheobronchomalacia.
  • Spontaneous closure likelihood decreased over time; tracheostomy tube size correlated with age.

Conclusions:

  • About 50% of pediatric tracheostomy sites close spontaneously.
  • Younger age at placement, longer tracheostomy duration, and tracheobronchomalacia are risk factors for persistent TCF.
  • Findings aid clinicians in anticipating outcomes after pediatric tracheostomy decannulation.
Abstract

Keywords:
DecannulationTracheocutaneous fistulaTracheomalaciaTracheostomy

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