Tracheostomy—A 10-year experience from a UK pediatric surgical center

      Abstract

      Background/Purpose

      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.

      Results

      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.

      Conclusion

      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.

      Index words

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      References

        • Alladi A.
        • Rao S.
        • Das K.
        • et al.
        Pediatric tracheostomy: a 13-year experience.
        Pediatr Surg Int. 2004; 20: 695-698
        • Hadfield P.J.
        • Lloyd-Faulconbridge R.V.
        • Almeyda J.
        • et al.
        The changing indications for paediatric tracheostomy.
        Int J Pediatr Otorhinolaryngol. 2003; 67: 7-10
        • Kremer B.
        • Botos-Kremer A.I.
        • Eckel H.E.
        • et al.
        Indications, complications, and surgical techniques for pediatric tracheostomies—an update.
        J Pediatr Surg. 2002; 37: 1556-1562
        • Swift A.C.
        • Rogers J.H.
        The changing indications for tracheostomy in children.
        J Laryngol Otol. 1987; 101: 1258-1262
        • Wetmore R.F.
        • Handler S.D.
        • Potsic W.P.
        Pediatric tracheostomy. Experience during the past decade.
        Ann Otol Rhinol Laryngol. 1982; 91: 628-632
        • Gilmore Jr, B.B.
        • Mickelson S.A.
        Pediatric tracheotomy. Controversies in management.
        Otolaryngol Clin North Am. 1986; 19: 141-151
        • Gianoli G.J.
        • Miller R.H.
        • Guarisco J.L.
        Tracheotomy in the first year of life.
        Ann Otol Rhinol Laryngol. 1990; 99: 896-901
        • Park J.Y.
        • Suskind D.L.
        • Prater D.
        • et al.
        Maturation of the pediatric tracheostomy stoma: effect on complications.
        Ann Otol Rhinol Laryngol. 1999; 108: 1115-1119
        • Arcand P.
        • Granger J.
        Pediatric tracheostomies: changing trends.
        J Otolaryngol. 1988; 17: 121-124
        • Wetmore R.F.
        • Marsh R.R.
        • Thompson M.E.
        • et al.
        Pediatric tracheostomy: a changing procedure?.
        Ann Otol Rhinol Laryngol. 1999; 108: 695-699
        • Pereira K.D.
        • MacGregor A.R.
        • Mitchell R.B.
        Complications of neonatal tracheostomy: a 5-year review.
        Otolaryngol Head Neck Surg. 2004; 131: 810-813
        • Midwinter K.I.
        • Carrie S.
        • Bull P.D.
        Paediatric tracheostomy: Sheffield experience 1979-1999.
        J Laryngol Otol. 2002; 116: 532-535
        • Butnaru C.S.
        • Colreavy M.P.
        • Ayari S.
        • et al.
        Tracheotomy in children: Evolution in indications.
        Int J Pediatr Otorhinolaryngol. 2006; 70: 115-119
        • Shinkwin C.A.
        • Gibbin K.P.
        Tracheostomy in children.
        J R Soc Med. 1996; 89: 188-192
        • Swift A.C.
        • Rogers J.H.
        The outcome of tracheostomy in children.
        J Laryngol Otol. 1987; 101: 936-939
        • Donnelly M.J.
        • Lacey P.D.
        • Maguire A.J.
        A twenty year (1971-1990) review of tracheostomies in a major paediatric hospital.
        Int J Pediatr Otorhinolaryngol. 1996; 35: 1-9
        • Simma B.
        • Spehler D.
        • Burger R.
        • et al.
        Tracheostomy in children.
        Eur J Pediatr. 1994; 153: 291-296
        • Joseph H.T.
        • Jani P.
        • Preece J.M.
        • et al.
        Paediatric tracheostomy: persistent tracheo-cutaneous fistula following decannulation.
        Int J Pediatr Otorhinolaryngol. 1991; 22: 231-236
        • Carr M.M.
        • Poje C.P.
        • Kingston L.
        • et al.
        Complications in pediatric tracheostomies.
        Laryngoscope. 2001; 111: 1925-1928