Tracheostomy in children

Abstract

We reviewed the records of 108 patients who had a tracheostomy performed over a 10-year period from July 1979 to April 1989. Median age at tracheostomy was 6 months (1 week-15 years). Indications for surgery were acquired subglottic stenosis (31.4%), bilateral vocal cord paralysis (22.2%), congenital airway malformations (22.2%) and tumours (11.1%). No epiglottis and no emergency situation had to be managed by tracheostomy. Operation was uneventful in all, but 8 patients (7.4%) developed a pneumothorax in the postoperative period. Twenty-one (19.5%) had severe complications during the cannulation period (tube obstruction in 11 patients with cardiorespiratory arrest in 4; dislocation of the tube in 6 patients). Fifteen patients (13.8%) had severe complications after decannulation (2 had a cardiorespiratory arrest); all 15 had to be recannulated. At the end of the study period 85 patients (78.7%) were successfully decannulated with a median period of tracheostomy of 486 days (8 days-6.6 years). The median hospital stay was 159 days (13 days-2.7 years). All patients could be discharged. Eight patients (7.4%) died but no death was related to tracheostomy. In summary the mortality rate is lower than reported in previous reviews and tracheostomy is a safe operation even in small children but cannula-related complications may lead to life-threatening events. The management of tracheostomized small children and infants in a highly staffed and monitored intensive care unit has allowed better handling of complications and has resulted in a reduction in cannula-related deaths.

Complications of percutaneous dilatational tracheostomy in children

“…First, is the procedure as safe as open tracheostomy and, secondly, is the incidence of late tracheal stenosis greater following PDT than after conventional tracheostomy? The overall complication rate after open tracheostomy in children is ≈ 20%, with pneumothorax and pneumomediastinum featuring prominently [6–8]. This figure is slightly higher than the complication rates reported for PDT in adults [1] but comparable with the complication rate following PDT in children reported in Toursarkissian et al .…”

Laser treatment of hemangiomas of the larynx and trachea

“…However, it was also shown that even with intensive guidance, this is not without severe side effects. Severe complication rates of 13.4-48.6% were found in populations of 58 to 420 children [28]. Tracheostomy-related mortality was between 0-1.9%.…”

Mandibular Distraction Osteogenesis in a Neonate

“…It is well recognized that tracheotomy in children can be associated with severe complications, such as accidental decannulation, tracheotomy tube obstruction, and pneumothorax, and less severe complications, such as tracheal granulations, respiratory infections, and cricoid cartilage injury. 5 Long-term sequelae include growth retardation, delayed speech and articulation difficulties, and behavioral problems. 6 Nunn et al 7 address this issue and demonstrate performing early mandibular advancement to facilitate decannulation.…”

“…Long-term tracheotomy is known to be associated with significant morbidity and to have adverse effects on language acquisition and social interaction. 5,6 Nunn et al 7 indicate that expedient decannulation is a major goal in optimal management of airway obstruction due to CFAs. They report 6 cases of CFAs with significant airway obstruction in which they performed "inverted L"-type mandibular advancements on patients at 3 to 10 months of age to facilitate early decannulation.…”