Indications of pediatric tracheostomy over the last 30 years: Has anything changed?

Abstract

ImportanceRecent reports have shown that the indications for pediatric tracheostomy have evolved over time. ObjectiveTo review the indications for pediatric tracheostomy over the last 30 years. DesignRetrospective chart review. SettingTertiary referral children's hospital. ParticipantsPatients who underwent tracheostomy. InterventionSurgical tracheostomy placement. Main outcomes and measuresMedical records for patients who underwent surgical tracheostomy over the 30-year study period (1984–2014) were reviewed. Patient characteristics including age, gender, birth-weight, gestational age and death were collected and compared with the primary indication for tracheostomy using bivariable analysis. ResultsFive hundred and one patients met inclusion criteria. The most common primary indications for tracheostomy were cardiopulmonary disease (34%) and neurological impairment (32%), followed by airway obstruction (19%), craniofacial (11%), and traumatic injury (4%). Over the last five years (2010–14) cardiopulmonary disease became the most common indication for tracheostomy. Conclusionsand Relevance: The indications for pediatric tracheostomy have evolved over the past 30 years. Infectious causes of airway obstruction and tracheostomy have almost disappeared. Tracheostomy is now most commonly performed in very premature patients with cardiopulmonary or neurological impairment who require prolonged ventilator support.