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Complications of tracheostomy in children: a systematic review
José Faibes Lubianca Neto1, Octavia Carvalhal Castagno2, Artur Koerig Schuster3
1Universidade Federal de Ciências da Saúde de Porto Alegre (UFCSPA), Disciplina de Otorrinolaringologia (ORL) e Programa de Pós-Graduação em Pediatria, Porto Alegre, RS, Brazil; Hospital da Criança Santo Antônio, Serviço de ORL Pediátrica, Programa Programa de Fellowship em ORL Pediátrica Otorrinolaringologia Pediátrica, Porto Alegre, RS, Brazil; Santa Casa de Misericórdia de Porto Alegre (UFCSPA), Serviço de ORL, Programa de Residência Médica em Otorrinolaringologia, Porto Alegre, RS, Brazil.
Insights
Pediatric tracheostomy has a 40% complication rate, with cutaneous lesions and granulomas being most common. While tracheostomy-related deaths are rare, overall mortality in these young patients is significant.
Area of Science:
- Pediatric surgery
- Otolaryngology
- Critical care medicine
Background:
- Tracheostomy complications are frequent in children, exceeding adult rates.
- Complications can occur during surgery, or in the early and late postoperative periods.
Approach:
- Systematic review of pediatric tracheostomy complications.
- Searched Latin American and Caribbean Health Sciences Literature and PubMed databases.
- Included cohort studies, case series, and systematic reviews published between 1978 and 2020.
Key Points:
- The average complication rate was 40%, associated with younger age, low birth weight, prematurity, comorbidities, and emergency procedures.
- Cutaneous lesions and granulomas were the most frequent complications.
- Tracheostomy-related mortality was up to 6%, primarily due to cannula obstruction or accidental decannulation.
Conclusions:
- Pediatric tracheostomy is linked to numerous complications.
- While tracheostomy-specific mortality is low, the overall mortality for pediatric patients with tracheostomies warrants attention.
Introduction:
Tracheostomy is a procedure that can be associated with several well-described complications in the literature, which can be divided into transoperative, early postoperative and late postoperative. When performed in children, these risks are more common than in adults.
Objective:
To perform a systematic review of complications, including deaths, in tracheostomized pediatric patients.
Methods:
A search was carried out for articles in the Latin American and Caribbean Health Sciences Literature and PubMed databases. Cohort studies and series reports were selected, in addition to systematic reviews, published between January 1978 and June 2020, with patients up to 18 years old, and written in English, Spanish or Portuguese.
Results:
1560 articles were found, of which 49 were included in this review. The average complication rate was 40%, which showed an association with age, birth weight, prematurity, comorbidities, and emergency procedures. The most common complications were cutaneous lesions and granulomas. Mortality related to the procedure reached up to 6% in children and was mainly related to cannula obstruction or accidental decannulation.
Conclusion:
Pediatric tracheostomy is associated with several complications. The tracheostomy-related mortality rate is low, but the overall mortality of tracheostomized patients is not negligible.
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