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.

Tracheostomy in pediatric burn patients

“…Past controversies about tracheostomies in burn patients have been resolved by current reports that indicate due to lower airway ventilation volumes and lower tracheostomy cuff pressures, tracheostomies are generally safe and effective [2,6,9,10]. However, although tracheostomies provide safe airways for pediatric burn patients, decisions on removal of tracheostomies may be influenced by age related factors and established guidelines for tracheostomy care to reduce time to decannulation have not been well studied especially in children [11,12].…”

Can we develop a protocol for the safe decannulation of tracheostomies in children less than 18 months old?

“…For most children who require a tracheostomy, the procedure is temporary and the tracheostomy can eventually be removed once the underlying condition has resolved spontaneously or has been corrected [1][2][3][4]. The decision to decannulate must not be taken lightly, however, as death has been reported even during supervised decannulation in hospital [5].…”

“…The presence of a blocked tube in the airway provides an additional test of the child's reserve--if they can manage despite this, they are more likely to have sufficient reserve not to develop problems during exercise or an upper respiratory tract infection. Some authors advocate just capping the current tube [4], while others prefer to change the tube for a small one, either immediately [6] or through progressively smaller sizes [1]. Fenestration of the tracheotomy tube prior to its capping has its advocates [7], although this carries risks including tube fracture, granulations entering the tube and misdirection of suction catheters.…”

Pre-anesthetic evaluation can play a crucial role in the determination of airway management in a child with oropharyngeal tumor

“…Some authors have reported that the incidence of complications encountered during open tracheostomy in children is as high as 20% [8]. These complications include dystrophic calcification in the region of the tracheostome, causing tracheostenosis, some to an extent of near total occlusion, or substantial granulation tissue above the tracheostomy that necessitated recannulation of the tracheostomy tube.…”