Early tracheostomy in severely burned pediatric patients: 16-year experience at a tertiary burn center in China

Abstract

Background: A tracheostomy is a lifesaving procedure in severely burned pediatric patients. Because of the complex operative procedures, higher incidence of complications, pulmonary infections and mortality, tracheostomy in pediatric patients has always been controversial, especially for children < 3 years of age. Our study aimed to describe the characteristics of severely burned pediatric patients who had a tracheostomy and to identify the risk factors associated with complications related to tracheostomies, so as to provide assistance and suggestions for the airway management of such patients.Method: Severely burned pediatric patients (aged ≤15 years of age) who had a tracheostomy between 1 January, 2004 and 31 December, 2019 were retrospectively reviewed. The following data were collected: age; gender; total burn surface area (TBSA); burn mechanism; inhalation injury; indication for tracheostomy; time from injury to tracheotomy; duration of ventilation; duration of tracheostomy, tracheotomy-related complications; and prognosis.Results: Sixty-five severely burned pediatric patients with tracheostomies were reviewed in this study, 70.6% were < 3 years of age. The 0-3 year age group had the largest number of tracheotomies and the highest incidence of tracheostomy-related complications. Tracheotomy-related complications occurred in 15 patients (23.1%); seven, and eight were early and late complications, respectively. There was no significant relationship between the risk factors that were analyzed and early complications, but TBSA%, ventilation time, and duration of tracheostomy were significantly related to late complications. Multivariate linear regression analysis indicated that age, TBSA%, inhalation injury, and ventilation time were independent variables influencing the duration of tracheostomy. Decannulation was carried out successfully in 96.7% (58/60) of surviving patients. Age (B = −0.011, p = 0.008), TBSA (B = 1.5, p = 0.006), inhalation injury (B = 1.07, p = 0.004), and ventilation time (B = 1.081, p = 0.000) were independent risk factors influencing the duration of tracheostomy. Five patients died (7.7%); no children died from tracheotomy-related complications.Conclusion: Early tracheostomy is a relatively safe and effective method for airway management in severely burned children; however, patients < 3 years of age should be evaluated for tracheostomy with greater caution due to the severity of the complications.