Pediatric tracheostomy: A large single‐center experience

Abstract

Objectives: To describe the epidemiology, specifically the indications, complications, and outcomes, of pediatric tracheostomies performed in one tertiary referral unit.Methods: Single-center retrospective cohort study of pediatric patients undergoing tracheostomy between May 2010 and May 2018 at the Newcastle upon Tyne Hospitals, United Kingdom.Results: One hundred seventy-two pediatric tracheostomies were performed during the study period with a median age of 141 (interquartile range [IQR] 51-484) days. The most common primary indication was long-term ventilation (38.4%, 66 of 172), followed by weaning from ventilation in cardiac patients (22.1%, 38 of 172). Only 5.2% (9 of 172) of our cohort underwent tracheostomy for subglottic stenosis. The vast majority of tracheostomies were performed electively, with just 6.4% (11 of 172) performed as an emergency procedure. Early and late complication rates were 9.8% (15 of 153) and 40.0% (61 of 153), respectively. Tracheostomy decannulation was successful in 44.4% of children (68 of 153). The median duration the tracheostomy was in situ was 397 (IQR 106-708) days. All-cause mortality was 22.1% (38 of 172), with tracheostomy-related mortality at 1.2% (2 of 172).Conclusion: We report one of the largest contemporary case series of pediatric tracheostomies. Present-day pediatric tracheostomy is primarily performed as an elective procedure in ventilated children under the age of 1 year. Pediatric tracheostomy should be considered as a long-term intervention in many children. Nevertheless, a large proportion of children are ultimately decannulated. It is important to acknowledge the significant morbidity associated with this intervention and the small-but-present risk of tracheostomy-related mortality.

Surgical tracheostomy in children with malignancy receiving intensive chemotherapy: A case series and review of literature

“…UK Paediatric Intensive Care audit network database analysis shows that tracheostomy is performed infrequently in children admitted to PICU (2% of all admissions) and only 3.5% tracheostomised children had a cancer diagnosis . In the absence of any evidence‐based recommendations for indication and timing, tracheostomy for prolonged ventilatory support is often delayed due to risk of complications and 7‐22% risk of death of which 2% is attributed to tracheostomy . One‐third of clinicians in UK PICUs would delay tracheostomy because of worry about complications associated with tracheostomy .…”

“…5 In the absence of any evidence-based recommendations for indication and timing, tracheostomy for prolonged ventilatory support is often delayed due to risk of complications and 7-22% risk of death of which 2% is attributed to tracheostomy. [1][2][3] One-third of clinicians in UK PICUs would delay tracheostomy because of worry about complications associated with tracheostomy. 5 In a similar survey, 81% of Canadian PICU clinicians believe that risks of tracheostomy do not outweigh benefits.…”

“…Surgical tracheostomy in children is associated with high incidence (18‐50%) of complications including dislodgement, obstruction, haemorrhage, infection, granuloma formation, and emphysema . It is infrequently performed in Paediatric Intensive Care Unit (PICU) patients compared to adults due to clinicians’ worry about complications associated with the procedure .…”

“…Surgical tracheostomy in children is associated with high incidence (18-50%) of complications including dislodgement, obstruction, haemorrhage, infection, granuloma formation, and emphysema. [1][2][3][4] It is infrequently performed in Paediatric Intensive Care Unit (PICU) patients compared to adults due to clinicians' worry about complications associated with the procedure. 5,6 However, surgical tracheostomy may be mandated in some children receiving intensive chemotherapy that require prolonged mechanical ventilatory support due to pulmonary insufficiency from large abdominal or intrathoracic malignant tumours with or without pleural effusion, ascites and lung infiltration.…”

“…, patients[1][2][3][4], who underwent tracheostomy for prolonged ventilatory support while receiving intensive chemotherapy and had severe myelosuppression, are described below. Two patients with inoperable low-grade brainstem glioma were tracheostomised for bulbar palsy.…”