Tracheostomy in children
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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.
Key words
Tracheostomy Children Complications Mortality Discharge homePreview
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References
- 1.Baer G (1892) Tracheotomie und Intubation im Kinderspital Zürich: Beobachtungen aus den Jahren 1874–1891. Diss ZürichGoogle Scholar
- 2.Black RJ, Baldwin DL, Johns AN (1984) Tracheostomy “decannulation-panic” in children: fact or fiction. J Laryngol Otol 98: 297–304PubMedGoogle Scholar
- 3.Bull MJ, Giran DJ, Sadore M, Birker D, Hearn D (1990) Improved outcome in Pierre Robin sequence: effect of multidisciplinary evaluation and management. Pediatrics 86: 294–301PubMedGoogle Scholar
- 4.Campbell JB, Morgan DW, Pearman K (1989) Experience with the homecare of tracheotomised paediatric patients. Arch Otorhinolaryngol 246: 345–348CrossRefPubMedGoogle Scholar
- 5.Carter P, Benjamin B (1983) Ten year review of pediatric tracheotomy. Ann Otol Rhinol Laryngol 92: 398–400PubMedGoogle Scholar
- 6.Freezer NJ, Beasley SW, Robertson CF (1990) Tracheostomy. Arch Dis Child 65: 123–126PubMedGoogle Scholar
- 7.Gilmore BB, Mickelson SA (1986) Pediatric tracheotomy. Controversies in management. Otolaryngol Clin N Am 19: 141–151Google Scholar
- 8.Haglund G, Bjure J, Claesson I, Ekstroem-Jodal B, Hjalmarson O, Jansson G, Svanborg M, Werkmaester-Kollberg K (1984) Long-term follow-up of infants under intensive care with tracheotomy during the period 1956–1965. Acta Anaesthesiol Scand 28: 166–173PubMedGoogle Scholar
- 9.Heffner JE, Miller KS, Sahn SA (1986) Tracheostomy in the intensive care unit. Part 2: Complications. Chest 90: 430–436PubMedGoogle Scholar
- 10.Hof E (1987) Surgical correction of laryngotracheal stenoses in children. Prog Pediatr Surg 21: 29–35PubMedGoogle Scholar
- 11.Jennings P (1987) Iatrogenic subglottic stenosis leading to tracheostomy in childhood. Lancet II: 631CrossRefGoogle Scholar
- 12.Kenna MA, Reilly JS, Stool SE (1987) Tracheotomy in preterm infant. Ann Otol Rhinol Laryngol 96: 68–71PubMedGoogle Scholar
- 13.Line WS, Hawkins DB, Kahlstrom EJ, MacLaughlin EF, Ensley JL (1986) Tracheotomy in infants and young children: the changing perspective 1970–1985. Laryngoscope 96: 510–515PubMedGoogle Scholar
- 14.Newlands WJ, McKerrow WS (1987) Pediatric tracheostomy. Fifty-seven operations in fifty-three children. J Laryngol Otol 101: 929–935PubMedGoogle Scholar
- 15.Prader A, Largo RH, Molinari L, Issler C (1989) Physical growth of Swiss children from birth to 20 years of age. First Zürich longitudinal study of growth and development. Helv Paediatr Acta 43 [Suppl]: 1–125Google Scholar
- 16.Ruben RJ, Newton L, Jornsay D, Stein R, Chambers H, Liquori J, Lawrence C (1982) Home care of the pediatric patient with tracheotomy. Ann Otol Rhinol Laryngol 91: 633–640PubMedGoogle Scholar
- 17.Singer LT, Kercsmar C, Legris G, Orlowski JP, Hill BP, Doershuk C (1989) Developmental sequelae of long-term infant tracheostomy. Dev Med Child Neurol 34: 224–230Google Scholar
- 18.Swift AC, Rogers JH (1987) The outcome of tracheostomy in children. J Laryngol Otol 101: 936–939PubMedGoogle Scholar
- 19.Swift AC, Rogers JH (1987) The changing indications for tracheostomy in children. J Laryngol Otol 101: 1258–1262PubMedGoogle Scholar
- 20.Wetmore RF, Handler SD, Potsic WP (1982) Pediatric tracheostomy. Experience during the past decade. Ann Rhinol Laryngol 91: 628–632Google Scholar
- 21.Willis R, Myer C, Miller R, Cotton RT (1987) Tracheotomy decannulation in the pediatric patient. Laryngoscope 97: 764–765PubMedGoogle Scholar