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Updated: Jun 3, 2025
Guidelines for Elective Pediatric Fiberoptic Intubation
Published on: January 17, 2011
Indications for tracheostomy placement in pediatric patients with cerebral palsy
Elizabeth Fisher1, Taher Valika2
1Northwestern University Feinberg School of Medicine, Chicago, IL, USA.
Insights
Children with cerebral palsy (CP) often require tracheostomy due to respiratory issues, with prolonged ventilation being the main reason. Decannulation rates for these patients are notably low, indicating a significant need for further research.
Area of Science:
- Pediatric Pulmonology
- Pediatric Neurology
- Otolaryngology
Background:
- Cerebral palsy (CP) is a leading neuromuscular disorder in children, increasing their risk of respiratory distress and potential tracheostomy placement.
- Existing research on tracheostomy indications in neurologically impaired children lacks specific focus on the CP population.
Purpose of the Study:
- To identify the primary indications for tracheostomy placement in children with CP.
- To determine the common sites of airway obstruction in this cohort.
- To evaluate the rate of decannulation among children with CP who underwent tracheostomy.
Main Methods:
- A retrospective chart review was conducted at a single center, analyzing patients with CP requiring tracheostomy between 2005 and 2023.
- Patients were classified based on the main reason for tracheostomy.
- Data on airway obstruction sites and decannulation dates were collected.
Main Results:
- Of 122 eligible patients with CP who underwent tracheostomy, 81% received it due to prolonged intubation or BiPAP dependence.
- Common airway obstructions included supraglottis (23%), tongue base (12%), and tracheobronchomalacia (24%).
- The decannulation rate was low, with only 3% of patients being decannulated.
Conclusions:
- Tracheostomy in children with CP is frequently a result of failed non-invasive ventilation, often performed at a young age.
- A diverse range of airway obstruction sites were observed in this population.
- The low decannulation rate highlights the need for further investigation into optimal tracheostomy indications and decannulation criteria for children with CP.
Background:
Cerebral palsy (CP) is the most common neuromuscular disorder in children, and children with CP are at increased risk of respiratory distress potentially requiring tracheostomy placement. Previous studies have characterized indications for tracheostomy in neurologically compromised children, however no studies focus specifically on children with CP. The purpose of this study was to identify the indications for tracheostomy placement, sites of airway obstruction, and rate of decannulation in children with CP.
Methods:
We conducted a single-center retrospective chart review of all patients who presented with cerebral palsy and required tracheostomy at our center between 2005 and 2023. Patients were categorized according to primary indication for tracheostomy placement. The most common sites of airway obstruction in the cohort were recorded. The date of decannulation was recorded for those patients who had undergone decannulation.
Results:
933 patients with tracheostomies were identified, of whom 169 (18 %) had CP and 122 met inclusion criteria. The median age at tracheostomy placement was 1.69 (IQR 0.539-6.609) years. The most common indications for tracheostomy placement were: prolonged intubation or BiPAP dependence (81 %), airway obstruction/hypotonia (13 %), and aspiration/recurrent respiratory infection (6 %). At the time of tracheostomy placement: 38 % of patients had a single site of upper airway obstruction, while 27 % had multi-level obstruction. The most common sites of upper airway obstruction were the supraglottis (23.0 %), tongue base (12 %), and the tonsils/pharyngeal wall (8 %). 24 % of patients had tracheobronchomalacia, and 16 % had subglottic stenosis. Among all patients, 4 of 122 (3 %) were ultimately decannulated.
Conclusions:
Patients in our cohort most often received tracheostomy after failure of less invasive ventilation therapies. Tracheostomy placement occurred at a young age. Patients presented with a variety of sites of airway obstruction. Decannulation rate in this cohort was low. Further work is needed to confirm indications for tracheostomy placement and decannulation rate in this population.
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