Tracheostomy in children: A population-based experience over 17 years

Introduction Tracheostomy is a lifesaving intervention with numerous complications. Objectives We describe the natural history of tracheostomy in children in a defined geographical area over a 17‐year period. Our primary aim is to stress the need for a consensus on pediatric tracheostomy care. Methods This retrospective study reviewed the charts of 72 children who had tracheostomy between January 1990 and January 2007. Indications for the procedure were divided into 3 groups: (1) upper airway obstruction at a well‐defined anatomic site (32 patients); (2) upper airway obstruction with a complex medical condition (24 patients); and (3) need for an access to the lower airway for long‐term ventilation and pulmonary care with normal airway anatomy (16 patients). Results The most common indication for tracheostomy was upper airway obstruction due to subglottic stenosis (15 patients, 21%) or as part of a complex craniofacial syndrome (15 patients, 21%). The duration of intubation prior to tracheostomy and the duration of hospitalization after tracheostomy varied markedly. Tracheocutaneous fistulae complicated 15 of the 38 (37%) decannulated patients. Tracheostomy infection occurred in 90% of the patients and tracheal granulation in 56%. Eleven (15%) deaths occurred, 10 were due to the underlying medical illness and 1 to a mucous plug. Conclusion The complications of tracheostomy in children are substantial. Surveillance and prompt interventions are necessary to overcome life‐threatening sequelae. A multidisciplinary (medical–surgical) approach provides better care for these highly vulnerable children. A consensus on pediatric tracheostomy care is needed. Pediatr Pulmonol. 2010; 45:487–493. © 2010 Wiley‐Liss, Inc.