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Tracheostomy in children

C A Shinkwin1, K P Gibbin

  • 1Department of Otolaryngology, University Hospital, Queen's Medical Centre, Nottingham, England.

Journal of the Royal Society of Medicine
|April 1, 1996
PubMed
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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.

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  • 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.