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Pediatr Pulmonol. 2010 May;45(5):487-93. doi: 10.1002/ppul.21206.

Tracheostomy in children: a population-based experience over 17 years.

Author information

1
Faculty of Medicine and Health Sciences, Department of Pediatrics, United Arab Emirates University, Al-Ain, United Arab Emirates.

Abstract

INTRODUCTION:

Tracheostomy is a lifesaving intervention with numerous complications.

OBJECTIVES:

We describe the natural history of tracheostomy in children in a defined geographical area over a 17-year period. Our primary aim is to stress the need for a consensus on pediatric tracheostomy care.

METHODS:

This retrospective study reviewed the charts of 72 children who had tracheostomy between January 1990 and January 2007. Indications for the procedure were divided into 3 groups: (1) upper airway obstruction at a well-defined anatomic site (32 patients); (2) upper airway obstruction with a complex medical condition (24 patients); and (3) need for an access to the lower airway for long-term ventilation and pulmonary care with normal airway anatomy (16 patients).

RESULTS:

The most common indication for tracheostomy was upper airway obstruction due to subglottic stenosis (15 patients, 21%) or as part of a complex craniofacial syndrome (15 patients, 21%). The duration of intubation prior to tracheostomy and the duration of hospitalization after tracheostomy varied markedly. Tracheocutaneous fistulae complicated 15 of the 38 (37%) decannulated patients. Tracheostomy infection occurred in 90% of the patients and tracheal granulation in 56%. Eleven (15%) deaths occurred, 10 were due to the underlying medical illness and 1 to a mucous plug.

CONCLUSION:

The complications of tracheostomy in children are substantial. Surveillance and prompt interventions are necessary to overcome life-threatening sequelae. A multidisciplinary (medical-surgical) approach provides better care for these highly vulnerable children. A consensus on pediatric tracheostomy care is needed.

PMID:
20425857
DOI:
10.1002/ppul.21206
[Indexed for MEDLINE]

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