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Tracheostomy in children
1Department of Otolaryngology, University Hospital, Queen's Medical Centre, Nottingham, England.
Insights
Pediatric tracheostomy, particularly in infants, is increasingly performed for subglottic stenosis. This study highlights low complication rates due to specialized care and parental education.
Area of Science:
- Pediatric Otolaryngology
- Pediatric Surgery
- Critical Care Medicine
Background:
- Tracheostomy in children presents unique risks compared to adults, with a notable shift in patient demographics and indications over the past two decades.
- Historically, tracheostomy was primarily for epiglottitis and laryngotracheobronchitis; current trends show a rise in infants requiring tracheostomy for subglottic stenosis secondary to intubation for respiratory distress syndrome and prematurity.
Purpose of the Study:
- To review the experience and outcomes of tracheostomies performed in children under 12 years old at a university hospital.
- To identify factors contributing to low morbidity and mortality rates in this pediatric population.
Main Methods:
- A retrospective review of 57 tracheostomies in 56 children under 12 years old managed electively by otolaryngologists.
- Data collected included patient age, indications for tracheostomy, duration of cannulation, complications, and decannulation rates.
Main Results:
- The majority of tracheostomies (70%) were performed in children under 1 year old, with upper airway obstruction (41 cases), predominantly subglottic stenosis (21 cases), being the most common indication.
- Over 91.4 accumulated years of tracheostomy use, 11 complications occurred, with one fatality (blocked tube). 39 children were decannulated, with a mean cannulation duration of 21 months.
Conclusions:
- The low morbidity and mortality observed in this series are attributed to management by otolaryngologists, intensive postoperative care, and comprehensive home care education for parents supported by specialist nurses.
- Effective management strategies are crucial for optimizing outcomes in pediatric tracheostomy patients, particularly those with subglottic stenosis.
Abstract:
Tracheostomy is more hazardous in children than in adults, and carries special risks in the very young. The past 20 years have seen a large shift in the age distribution of tracheostomy. Whereas formerly the operation was done largely for management of epiglottitis and laryngotracheobronchitis, today the prime indication is subglottic stenosis in infants consequent upon intubation for respiratory distress syndrome and prematurity. We have reviewed experience with 57 tracheostomies in 56 children under 12 years old managed from a university hospital. All operations were done as elective procedures, in standard fashion, by otolaryngologists. Forty (70%) were in children under 1 year old, the indications being upper airways obstruction (41), failed extubation (11), and long-term assisted ventilation (5). Subglottic stenosis was the commonest cause of obstruction (21 operations). In 91.4 accumulated years with a tracheostomy there were 11 complications related to tracheostomy, one of which (a blocked tube) was fatal. Thirty-nine children were decannulated, the mean duration of cannulation being 21 months. In this series we suggest that the low morbidity and mortality rates were due to management by otolaryngologists; to postoperative intensive care; and, for the majority cared for at home, to careful education of parents and visits by specialist nurses.