Endoscopic Assessment in Children With Tracheotomies

Endoscopic KTP laser excision of severe tracheotomy-associated suprastomal collapse

“…It typically develops between 3 weeks and 6 months after tracheotomy [2,3], due to pressure exerted on the tracheal cartilage by the shape of the tracheotomy tube and the direction of pull of the tracheotomy ties [1]. Early on, the depressed segment is easily evertible with a rigid bronchoscope [1], or by simply removing the tracheotomy tube [5].…”

“…Although small areas of suprastomal collapse require no treatment, large obstructing segments must be managed before decannulation [3]. Suprastomal collapse may be a contributing factor in decannulation failure in 2.4-18% of children with tracheotomy [1,2,[6][7][8].…”

“…Significant suprastomal collapse can be managed by removing the tracheotomy tube and stenting the trachea with an endotracheal tube for 24-72 h [3,6,7]. However, an endotracheal tube of sufficient diameter to elevate the depressed tracheal segment may risk injury to the pediatric subglottis [1].…”

“…Some authors have advocated placing a subcutaneous suture to evert the collapsed cartilage segment out of the tracheal lumen [3,6,7]. Alternatively, the stoma tract can be dissected down to the trachea and excised, and the displaced trachea can be ''hitched'' forward with sutures to the strap muscles on either side [8].…”

“…Although not often reported, some authors suspect that suprastomal collapse occurs more frequently than recognized [3], and is probably the cause of many unexplained decannulation failures [2].…”