Tracheostomy in children: an ancient procedure still under debate

Abstract

Tracheostomy is one of the oldest surgical procedures reported in ancient medicine books. It became widely used in the 19th century during the diphtheria epidemics in Europe, and then in the 20th century following a series of devastating poliomyelitis epidemics in the 1950s [1–3]. Around the turn of the 20th century, Jackson [4] standardised the indications for tracheostomy, the technique itself and the instruments used; he developed anatomically correct tracheostomy tubes and paved the way for further improvement of the technique. The role of tracheostomy in the ventilatory management of the critically ill adult has been endorsed by the American College of Chest Physicians to improve patients’ comfort, to reduce the incidence of pneumonia and to facilitate respiratory weaning [5]. Adults that are clinically stable and necessitate prolonged mechanical ventilation have an indication for tracheostomy [5]; patients with acute respiratory failure, acute exacerbations of chronic pulmonary disease, coma and neuromuscular disorders may also require it [6, 7]. While tracheostomy in adults is accepted, in children it is perceived as an aggressive procedure, but over time the indication in paediatrics has changed from an emergency procedure during diphtheria and poliomyelitis epidemics into aid for children dependent on assisted ventilation. In children the most frequent indications are upper airway obstruction (craniofacial malformations, craniofacial and laryngeal tumours, and obstructive sleep apnoea), …