Tracheostomy-related Tracheal Tears in Pediatrics.

Abstract

Tracheostomy-related tracheal tear is a serious complication that may follow surgical or percutaneous tracheostomy. Pediatric populations carry a higher risk because of anatomical differences. The aim of this article is to review this condition and to help in its diagnosis and management with the assistance of clinical and radiological findings. An English literature review was done using the terms pediatric, tracheostomy, tracheal tear and tracheostomy tube. Two cases reported in the literature met the criteria to be included in the review. Tracheostomy-related tracheal tear needs immediate diagnosis as it may lead to life-threatening outcomes, such as pneumothorax, respiratory distress, extensive subcutaneous emphysema and pneumomediastinum. Symptoms and complications of the tear may occur intraoperatively or postoperatively. Gold standard methods for diagnosis include flexible or rigid tracheobronchoscopy, which helps in determining the management plan. The treatment choices for iatrogenic tracheal tears depend on the tear site, size, and extension of the tear and patient's hemodynamic status. Conservative management is sufficient for stable patients with small tears, whereas surgical management is essential for unstable patients and those with large or complicated tears. Tracheostomy-related tracheal tear is a serious rare complication. The pediatric age group carries a higher risk of the condition and its management, either conservative or surgical, depends on airway endoscopy findings and patient's hemodynamic status.