Adolescent Tracheostomy for COVID-19 Respiratory Failure

Abstract

Pediatric tracheostomy for COVID-19 infections is uncommon and requires age-appropriate adaptations. This case adds to a limited body of literature related to tracheostomy placement and management in an adolescent. Thoughtful planning and communication by a dedicated tracheostomy team was crucial in obtaining a successful outcome.

Good outcome of tracheostomy in a COVID‐19 child with Joubert syndrome—Case report

“…Tracheostomy reports in children with COVID‐19 infections are scarce, 8 , 9 , 10 as severe forms of COVID‐19 are rarer in children compared with adults.…”

“…Finally, hospitalization after tracheostomy in children is often prolonged due to caregiver training and discharge barriers. Taken together, these factors explain why teams caring for children might cautiously approach decisions to proceed with tracheostomy 8–10 . Complications of tracheostomy procedure in COVID‐19 patients are as follows: increased intraoperatory hemorrhage due to anticoagulant treatment (16.6%–24%), ulcers and granulations around stoma and in the larynx, tracheomalacia, crust formation inside the tracheal tube with concomitant blockage, air leak, and accidental decannulation 8,10 …”

“…Taken together, these factors explain why teams caring for children might cautiously approach decisions to proceed with tracheostomy. [8][9][10] Complications of tracheostomy procedure in COVID-19 patients are as follows: increased intraoperatory hemorrhage due to anticoagulant treatment (16.6%-24%), ulcers and granulations around stoma and in the larynx, tracheomalacia, crust formation inside the tracheal tube with concomitant blockage, air leak, and accidental decannulation. 8,10 Due to reduced number of cases, decannulation rate in children remains unestimated; one study 8 on 18 children with tracheostomies performed during severe COVID-19 infection reports 23.5 days (16-31 days) as the mean time between tracheostomy and decannulation and approximately 50% decannulation rate in children.…”