The role of postoperative chest radiography in pediatric tracheotomy

Utility of routine postoperative chest radiography in pediatric tracheostomy

“…Previous studies have additionally found that more complications tend to occur when the operation is performed emergently [7,8]. In a study of 200 consecutive pediatric tracheostomy cases by Greenberg et al [10], children who underwent emergent tracheostomy experienced a PTX at a rate of 20%, while those of undergoing elective operations experienced them at a rate of 0.05%. The authors further identified age less than 2 year and weight less than 17 kg as significant risk factors for PTX.…”

“…In contrast, Greenberg et al [10] reviewed 200 patients from January 1994 to June 1999 and found 5 complications on CXR (2 PTX, 1 PM, 1 subcutaneous emphysema, and 1 tube displacement). Of the 2 patients with PTX, 1 had an emergent tracheostomy performed in the labor and delivery suite for laryngeal atresia, and one patient was afflicted with end-stage leukemia complicated by ARDS and suffered a ruptured alveolar bleb.…”

“…These complications may be identified on postoperative chest radiographs (CXRs), prompting many institutions to perform a postoperative CXR after tracheostomy routinely. Initial studies reported rather high rates of early perioperative complications following pediatric tracheostomy [6][7][8][9], but more recent studies have reported much lower complication rates [10][11][12]. Despite the reported lower rate of complications, these recent studies have come to varying conclusions regarding the utility of routine postoperative CXR following pediatric tracheostomy [10][11][12].…”

“…Initial studies reported rather high rates of early perioperative complications following pediatric tracheostomy [6][7][8][9], but more recent studies have reported much lower complication rates [10][11][12]. Despite the reported lower rate of complications, these recent studies have come to varying conclusions regarding the utility of routine postoperative CXR following pediatric tracheostomy [10][11][12]. Given the uncertainty surrounding the utility of routine postoperative CXR following pediatric tracheostomy, we examined the medical records of all children who underwent tracheostomy at our institution from January 1, 2000 to April 1, 2009 in order to evaluate the incidence of perioperative complications and inform decisions regarding the utility of routine postoperative CXR.…”

Complications in paediatric airway management

“…A meticulously performed tracheostomy will also avoid undue hemorrhage. The use of a chest X-ray immediately following tracheostomy not only confirms the position of the tube but also rules out the presence of a pneumothorax, and should be performed as a routine [21]. It is the policy in our department to perform a routine chest X-ray in the recovery area following a tracheostomy.…”