Pediatric Tracheostomy: A Changing Procedure?

Abstract

In 1982, the experience with tracheostomy at The Children's Hospital of Philadelphia was reported for 1971 through 1980. We have now reviewed 450 cases for the period from 1981 through 1992, and compared the characteristics of these cases with those in the previous review. Long-term follow-up was available on 83% of cases, and the median follow-up was 2.96 years. Patients received a tracheostomy for airway obstruction (38%), chronic ventilation (53%), or multiple indications (9%). The mean duration of tracheotomy (adjusted for death and loss to follow-up) was 2.13 years. The tracheostomy-related mortality was 0.5%, and the nontracheostomy-related mortality was 22%. Nineteen percent of patients had complications in the first postoperative week, and 58% had 1 or more late complications. In comparison with the previous study from our institution, there was a great increase in long-term tracheostomy and a continuing trend away from tracheostomy for short-term airway management. Better monitoring and improvements in parental teaching may have contributed to a decrease in tracheostomy-related mortality.

Laryngotracheoplasty as an Alternative to Tracheotomy in Infants Younger Than 6 Months

“…The criterion standard for treatment of airway obstruction, including SGS, has been the tracheotomy first standardized by Chevalier Jackson. However, given the relatively high rates of morbidity and occasional mortality 2,3 associated with neonatal tracheotomy, there has been substantial impetus to find alternatives for treating SGS.…”

Interfaces for long-term noninvasive positive pressure ventilation in children

“…While it has been used in children and adolescents suffering from these various disorders for many years, more recently it is also being used in younger patients and patients with various diseases associated to severe bilateral facial deformities, such as Goldenhar syndrome, Treacher Collins syndrome, achondroplasia, craniostenosis, and Down syndrome [1][2][3]. In these patients, NPPV represents an interesting noninvasive alternative to tracheostomy, which is associated with significant morbidity and may impair normal development and, particularly, language development [4,5]. Discomfort and disruption of social and family life are common consequences of patients with a tracheostomy.…”

Mandibular Distraction to Relieve Airway Obstruction in Children With Cerebral Palsy

“…It remains the only proven means of alleviating the tongue base level airway obstruction. Without tracheotomy, these patients are likely to have progressive upper airway obstruction, obstructive sleep apnea with pulmonary hypertension, cor pul- 17 Pediatric tracheotomy-specific mortality rates have decreased to 0% to 3.4%. 1,2,[18][19][20] Despite these improvements, the risks associated with tracheotomy, such as subglottic stenosis, airway obstruction, granulation tissue, bleeding, and death, must be considered and discussed with the families.…”