Pediatric Tracheotomies: Changing Indications and Outcomes

Abstract

Objective/Hypothesis: To study the outcomes and complications associated with pediatric tracheotomy, as well as the changing trend in indications and out· comes since 1970. Study Design: Retrospective chart review at a major tertiary care children's hospital. Methods:On childr~n who underwent tracheotomy at Children's Hospital of the King's Daughters (Norfolk, VA) between 1988 and 1998, inpatient and outpatient records were reviewed. Of 218 tracheotomies, sufficient data were available on 204. Indications for tracheotomy were placed into the following six groups: craniofacial abnormalities (13%), upper airway ob· struction (19o/ o), prolonged intubation (26%), neuro· logical impairment (27%), trauma (7%), and vocal fold paralysis (7%). Results: The average age at tracheotomy was 3.2 ± 0.6 years. Although the prolonged in· tubation group was significantly younger than all others, the neurological impairment and trauma groups were significantly older. Decannulation was accomplished in 41 %. Time to decannulation was significantly higher in the neurological impairment and prolonged intubation groups, but was significantly shorter in the craniofacial group. Complications occurred in 44%. Overall mortality was 19o/ o, with a 3.6% tracheotomy-related death rate. Comparison of our series to other published series of pediatric tracheotomies since 1970 shows fewer being performed for airway infections and more for chronic diseases, with a corresponding increase in duration of tracheotomy and decreased decannulation rates. Conclusions: Tracheotomy is a procedure performed with relative frequency at tertiary care children's hospitals. While children receiving a tracheotomy have a high overall mortality, deaths are usually related to the underlying disease, not the tracheotomy itself.

Traqueostomia na criança

“…5 While the principal indications for tracheostomy in children have remained the same over the last 20 years, countless tendencies become apparent when descriptions of case reported that the incidence of tracheostomy has reduced in relation to the number of hospital admissions, although the absolute number of tracheostomies per year has remained unaltered. The same study, in conjunction with another recently-published study, 12 showed that patients are being tracheostomized for longer periods, perhaps because they are children chronically dependent on mechanical ventilation.…”

“…Nevertheless, it is most frequently performed on children less than 1 year old. [11][12][13][14] The increase in tracheostomies within this age group has been attributed to increases in the survival of premature newborn infants and those requiring prolonged ventilation. 4 The decision to perform a tracheostomy on a child is complex and depends on several factors, including the severity of airway obstruction, the difficulty and duration of intubation and the child's subjacent medical condition.…”

Pediatric Tracheotomies: A 5-Year Experience in Düzce University Medical Faculty

“…Early complications, such as displacement of the tracheotomy cannula and pneumothorax, have been reported to occur at high rates ranging from 53% to 61% in various series (18,19). Owing to performing tracheotomy under general anesthesia in an operating room and due to the decreased number of emergency tracheotomies performed due to acute infection, serious early complications, such as pneumothorax and pneumomediastinum, have decreased since the 1970s.…”

Tracheostomy in Infants With Congenital Heart Disease: A Nationwide Population-Based Study in Taiwan

“…5,6 Although infections have historically been the most common indication, 7 tracheos-tomies are increasingly indicated for prolonged ventilator dependence in children with chronic complex health conditions. 6,[8][9][10][11][12] However, most studies have focused on the indications for tracheostomy, the subsequent outcomes, or resource utilization. 6,[10][11][12][13][14][15][16][17][18][19][20][21][22] Data are scant regarding the epidemiological risk factors for tracheostomy in CHD, and there have been no large-scale population-based studies.…”