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Paediatric tracheostomy. Fifty-seven operations on fifty-three children
1Royal Aberdeen Children's Hospital.
Insights
Pediatric tracheostomy complications decreased significantly with the rise of nasotracheal intubation. Tracheostomy remains essential for specific airway obstruction cases in children.
Area of Science:
- Pediatric Surgery
- Otolaryngology
- Respiratory Medicine
Background:
- Tracheostomy was a primary intervention for pediatric airway obstruction between 1964-1985.
- The study reviewed 57 tracheostomies in 53 children under 13.
- Complication rates varied significantly by age group.
Purpose of the Study:
- To analyze the outcomes and evolving indications for pediatric tracheostomy.
- To compare complication rates between different age groups and time periods.
- To assess the impact of nasotracheal intubation on tracheostomy use.
Main Methods:
- Retrospective review of pediatric tracheostomy cases.
- Data collection on patient demographics, surgical procedures, and complications.
- Analysis of complication rates in relation to age and intervention type.
Main Results:
- Overall complication rate was 35%, with higher rates (53%) in children under three.
- No intraoperative complications or procedure-related deaths occurred.
- Nasotracheal intubation, introduced in 1973, reduced the need for tracheostomy, especially for acute infections.
Conclusions:
- Pediatric tracheostomy has a low mortality but significant morbidity, particularly in younger children.
- Nasotracheal intubation is a safer alternative for acute airway obstruction.
- Tracheostomy remains crucial for persistent or complex airway obstruction, congenital anomalies, and trauma.
Abstract:
Fifty-seven operations on 53 patients represents the total experience of tracheostomy in children under 13 years during 1964-1985 in an area with half a million inhabitants. No complication occurred during surgery and no deaths were related to the operations. Complications followed 16 out of 30 (53%) operations on children under three years and four out of 27 (15%) of the remainder, an overall complication rate of 35%. Many fewer operations have been required since 1973 because of the successful employment of nasotracheal intubation in the treatment of upper and lower airway obstruction caused by acute infection. Obstruction by-pass remains the commonest function of tracheostomy, with congenital lesions and trauma now the commonest causes of obstruction as opposed to acute infection in the earlier years. Despite the successful use of nasotracheal intubation there were absolute indications for tracheostomy--blockage of the nasotracheal tube; inability to intubate a child with epiglottitis; and necessity for an artificial airway of long duration.