Paediatric patients with a tracheostomy: a multicentre epidemiological study

Abstract

Changes in the indications for tracheostomy in children have led to the progressively greater involvement of the paediatric pulmonologist in the care of these patients. The aim of this study was to review the current profile of tracheostomised children in Spain.We undertook a longitudinal, multicentre study over 2 yrs (2008 and 2009) of all patients aged between 1 day and 18 yrs who had a tracheostomy.The study, involving 18 Spanish hospitals, included 249 patients, of whom 150 (60.2%) were ,1 yr of age. The main indications for the procedure were prolonged ventilation (n5156, 62.6%), acquired subglottic stenosis (n534, 13.6%), congenital or acquired craniofacial anomalies (n525, 10%) and congenital airway anomalies (n524, 9.6%). The most frequent underlying disorders were neurological diseases (n5126, 50.6%) and respiratory diseases (n598, 39.3%). Over the 2-yr study period, 92 (36.9%) children required ventilatory support, and decannulation was achieved in 59 (23.7%). Complications arose in 117 patients (46.9%). Mortality attributed to the underlying condition was 12.5% and that related directly to the tracheostomy was 3.2%.Respiratory complexity of tracheostomised children necessitates prolonged, multidisciplinary follow-up, which can often extend to adulthood.

Improving the quality of tracheostomy care

“…However, the vast majority of paediatric tracheotomies are performed by ENT or paediatric surgeons in the operating room with the child intubated under general anaesthesia. The tracheostomy is likely to remain in place for a period of months to years [6] and children with a tracheostomy experience lengthy and costly hospitalisations [7].…”

Tracheostomy in children: an ancient procedure still under debate

“…In the 2-yr longitudinal multicentre study involving 22 Spanish hospitals by PÉ REZ-RUIZ et al [13] in this issue of the European Respiratory Journal, indications, duration and complications are reported in 249 tracheostomised children, aged between 1 day and 18 yrs at the beginning of the study. To our knowledge this is the largest case series published in the English literature on this topic.…”

“…In the Spanish paper the duration of tracheostomy ranged from 1 day to 19 yrs, with a median duration of 34 months in children persistently tracheostomised during the 2-yr study period [13]. In 130 children (45.4%) the intervention of tracheostomy was performed under 6 months of age, as a result of a condition predisposing to extubation failure and to tracheostomy [12].…”

“…In children the most frequent indications are upper airway obstruction (craniofacial malformations, craniofacial and laryngeal tumours, and obstructive sleep apnoea), laryngotracheal abnormalities (bilateral vocal cord paralysis, laryngeal obstruction, severe tracheomalacia and subglottic stenosis due to intubation in premature infants), need for long term ventilation (irreversible neuromuscolar conditions and central nervous system conditions), chronic respiratory disease (bronchopulmonary dysplasia in children aged 1 yr or younger) and failure of extubation [8][9][10][11][12][13].…”

“…Only 9% of all patients were treated in hospital units, while 91% were cared at home; these data emphasise the importance of the nursing support and educational aid at home in the management of tracheostomy in these patients. Also, in the Spanish survey educational support was provided in 79% of cases both in hospital and at home [13].…”