Tracheostomy in the pediatric population is associated with significant morbidity
and mortality compared to adult practice. This study highlights evolving experience
from a UK children's hospital.
Patients and Methods
All children undergoing tracheostomy between 1995 and 2004 were identified. Indications,
complications, and outcomes were evaluated.
Complete case records were reviewed for 112 children (age range, newborn–18 years).
Indications included congenital birth defects—craniofacial disorders, esophageal atresia,
laryngeal cleft, cystic hygroma, vascular malformations. Acquired upper airway pathology
(15.5%) and malacia (12.1%) were additional criteria. Tracheostomy was also required
for long-term ventilation in patients with neuromuscular disorders (12.1%) or ventilator
dependency (26.7 %).
Fifty-eight (50%) tracheostomies were created in infants <1 year. One hundred and
nine were elective procedures with only 7 (6%) for emergency airway management. Morbidity
included wound problems (14, 14.4%), tube displacement or obstruction (14, 14.4%),
tracheocutaneous fistula (6, 6.2%), and pneumothorax (4, 4.1%). There were no acute
hemorrhagic complications. Two children died after accidental tube displacement/obstruction.
Tracheostomy at this UK center is largely undertaken as an elective procedure. Children
less than 1 year form an increasing patient group. Complications may be minimized
by meticulous surgical technique and ensuring a comprehensive tracheostomy care program.