Abstract
IntroductionChildren may require tracheostomy due to many different health conditions. Over the last 40 years, indications of tracheostomy have endorsed substantial modifications. ObjectiveTo evaluate pediatric patients warranted tracheostomy at our Hospital, in regard to their indications, associated comorbidities, complications and decannulation rates. MethodsRetrospective study concerning patients under 18 years of age undergoing tracheostomy in a tertiary health care center, from January 2006 to November 2015. Results123 children required a tracheostomy after ENT evaluation during the study period. A proportion of 63% was male, and 56% was under one year of age. Glossoptosis was the most common indication (30%), followed by subglottic stenosis (16%) and pharyngomalacia (11%). The mortality rate was 31%. By the end of this review, 35 children (28.4%) had been decannulated, and the fewer the number of comorbidities, the greater the decannulation rate (0.77±0.84 vs. 1.7±1.00 comorbidities; p<0.001). ConclusionTracheostomy in children is a relatively frequent procedure at our hospital. The most common indications are glossoptosis and subglottic stenosis. A high mortality rate was found, potentially substantiated by the high number of critical care patients with chronic neurological conditions in this cohort. Our decannulation rate is slightly below other series, probably because of the greater amount of patients with comorbidities.
Highlights
Tracheostomy is one of the oldest and most commonly performed surgical procedures among critically ill patients
A life saving surgery, tracheostomy in children is more challenging when compared to those performed in adults, and it is associated with higher rates of morbidity and mortality
Between January 2006 and November 2015, 146 children evaluated by the ENT Unit required a tracheostomy
Summary
Tracheostomy is one of the oldest and most commonly performed surgical procedures among critically ill patients. Children require tracheostomy for many different reasons, and those with a chronic tracheostomy constitute an important subgroup of children who are at risk for airway compromise. A life saving surgery, tracheostomy in children is more challenging when compared to those performed in adults, and it is associated with higher rates of morbidity and mortality. The risk of complications increases with age among pediatric patients.[1,2]. During 1970s, the main indication of tracheostomy was upper airway obstruction secondary to an acute inflammatory disease such as epiglottitis, croup or laringotracheitis.[2] With the introduction of vaccines against Haemophilus influenzae and Corynebacterium diphteriae and the adoption of routine use of endotracheal intubation as an alternative to tracheostomy, there was a decline in such indications
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