Trends in the use of tracheotomy in the pediatric patient: The Iowa experience

Abstract

Mean age, duration of tracheotomy, and indications for tracheotomy changed over the 15-year period. Additionally, these parameters were strongly related.

Current trends in paediatric tracheostomies

“…Our overall complication rate (36.8%) was comparable to those reported by other authors [2,18,19]. Younger children (under 1 year of age) had a higher complication rate (47.4%) than older cases (26.3%), as in other series [11,13,15], in which complication rates of 63, 64 and 70%, respectively, were observed in children belonging to the same age group.…”

“…The mean age of the patients' population was 27.5 months, ranging from 20 days to 14 years. Fifty percent of patients (19) were under 1 year of age at the time of tracheostomy.…”

Tracheotomy in children: Evolution in indications

“…Acute epiglottitis and laryngotracheobronchitis no longer represent an indication for tracheotomy due to introduction of endotracheal intubation in the 1970s and 1980s [12,13] and more recently, Haemophilus influenzae type B vaccine for acute epiglottitis.…”

“…Modern techniques in pediatric ICU have permitted a reduction in the number of tracheotomies performed in children in an acute setting [4][5][6][7][8]. But prolonged endotracheal intubation has (1) prolonged ventilator dependence (57%), (2) upper airway obstructions (43%).…”

Non-invasive ventilation in children with upper airway obstruction

“…Traditionally, upper airway obstuction has been managed through the provision of an airway; most commonly via endotracheal intubation in the short term or tracheostomy for longer periods. Tracheostomy in the paediatric population is associated with significant morbidity and mortality, requires considerable care and alternatives to tracheostomy should be sought when possible [1][2][3][4]. Advances in non-invasive treatments, including medical treatment, nursing and assisted ventilation, have resulted in a decreasing rate of tracheostomy insertion over the last decades.…”