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Tracheotomy in infants and young children: the changing perspective 1970-1985
Insights
Pediatric tracheotomy rates have declined due to advances in intubation techniques. However, tracheotomies are now longer for children with complex conditions, with significant early and late complication rates.
Area of Science:
- Pediatric Otolaryngology
- Pediatric Surgery
- Pediatric Critical Care
Background:
- Tracheotomy in children under 3 years old was historically common for airway obstruction.
- Advances in endotracheal intubation have reduced the need for early tracheotomy in acute infections and for ventilation.
- Improved medical care has increased survival rates for children with multiple congenital abnormalities, leading to prolonged tracheotomy use.
Purpose of the Study:
- To review the trends and outcomes of tracheotomies performed in young children over a 15-year period.
- To analyze changes in indications for pediatric tracheotomy.
- To assess the incidence of early and late complications associated with pediatric tracheotomy.
Main Methods:
- Retrospective review of 153 children aged 3 years or younger who underwent tracheotomy.
- Analysis of tracheotomy procedures over three 5-year intervals.
- Evaluation of complication rates and changes in patient demographics and indications.
Main Results:
- The number of tracheotomies decreased significantly over the 15 years (73 to 55 to 25).
- Tracheotomies became longer in duration for children with multiple abnormalities due to improved survival.
- Early complications occurred in 12% of patients, and late complications occurred in 26%.
Conclusions:
- While the overall number of pediatric tracheotomies has decreased, their use in specific complex cases has increased in duration.
- Pediatric tracheotomy management requires careful attention to both early and late complications.
- Despite evolving indications, fundamental principles of pediatric tracheotomy care remain consistent.
Abstract:
One hundred fifty-three children 3 years of age or younger who had tracheotomies performed during the past 15 years are reviewed. During this time, short-term endotracheal intubation for airway obstruction from acute infections and long-term intubation for patients on ventilators have replaced early tracheotomy for these conditions. The number of tracheotomies decreased during each of three 5-year periods, from 73 to 55 to 25, respectively. Improvements in medical management resulted in prolonged survival of children with multiple abnormalities and resulted in more prolonged tracheotomies. Early complications occurred in 12% of patients and late complications occurred in 26%. In spite of changes in the indications, basic fundamentals of pediatric tracheotomy management remain unchanged.