A retrospective analysis of pediatric tracheostomy patients in PICU

Abstract

Background : Pediatric tracheostomy is always a matter of debate. There is no consensus about outcome of pediatric tracheostomy. So this study was proposed to analysis the indications, duration and outcome of pediatric tracheostomy patients in our PICU in a retrospective manner. Methods : We conducted a retrospective chart review of consecutive patients undergoing tracheostomy at PICU of medical college Kolkata, from January 2014 to December 2016. Patient age, sex, emergency or planned tracheostomy, type of tube used, average number of days patient was on ventilation before tracheostomy, indications, complications, and decannulation time were all assessed. Bronchoscopy was done in all cases of difficult decannulation and where clinician decided. Results : In this two years duration total 32 patients undergone tracheostomy in our unit. All tracheostomy procedure was done in ENT OT using open method using Protex tube. Most common indication was prolonged ventilation (87.5%) followed by difficulty in maintaining airway and airway obstruction. Most common disease needing tracheostomy due to prolonged ventilation was encephalitis (71.4%) followed by GB syndrome (14.28%). Average day of ventilation was 10 before tracheostomy. Among this patient 5(15.62%) died due to primary disease related cause and in two of case decannulation was not possible. No patient died due to complication of tracheostomy. Early side effects like hemorrhage (21.8%), accidental decannulation (6.25%) was seen and one needed bronchoscopy guided laser surgery to remove granuloma before decannulation. Conclusion : In our study it was found that tracheostomy helped in prolonged ventilation and decannulation rate is also high in comparison with other studies. Major complications like tracheoesophageal fistula, tracheocutaneous fistula, subglottic stenosis (only one case) are rare. So choosing early tracheostomy in indicated cases we can avoid complications of prolonged intubation.