Pediatric tracheotomy: indications and decannulation outcomes

Abstract

Objectives/hypothesis: The objective of this study was to determine if there are differences in decannulation rates and duration of cannulation between pediatric patients undergoing tracheotomy for different indications.

Study design: Retrospective chart review.

Methods: Medical records for pediatric patients (age 0-18 years) undergoing tracheotomy between January 1, 2003, and May 31, 2012, were retrospectively reviewed. Patients were assigned an indication for tracheotomy from five categories: neurological, cardiopulmonary, upper airway obstruction, craniofacial anomalies, and maxillofacial/laryngotracheal trauma.

Results: Initial chart review identified 124 patients, 113 for whom complete data was available. Of these patients, the indications for tracheotomy were cardiopulmonary disease in 24 (21.2%), craniofacial anomalies in 12 (10.6%), neurological impairment in 44 (38.9%), traumatic injury in 11 (9.7%), and upper airway obstruction in 22 (19.5%). The time to decannulation was shorter for trauma patients compared to cardiopulmonary (P = 0.044) and neurological patients (P = 0.001). A total of 32 (31.9%) patients were decannulated during the study period, with a higher rate in trauma patients (72.7%) and a lower rate in those with upper airway obstruction (36.4%) than would be expected under homogeneity. Of the 32 patients who were decannulated, 11 (30.6%) were decannulated during the same hospitalization in which the tracheotomy was performed.

Conclusion: This study demonstrates a difference in overall decannulation rates and a shorter time to decannulation in children undergoing tracheotomy for maxillofacial and laryngotracheal trauma compared to cardiopulmonary and neurological indications.

Keywords: Pediatric tracheotomy; decannulation; tracheostomy; upper airway obstruction.

Figure 1

Kaplan-Meier curves demonstrating time to decannulation, which is shorter for trauma patients compared to other indications (P = 0.002 for comparison of trauma with cardiopulmonary, P < 0.001 for all other groups).

Figure 2

Boxplots of age at time of tracheotomy by indication. The age at tracheotomy was significantly older in trauma patients than in cardiopulmonary (P = 0.003), craniofacial (P < 0.001), and upper airway obstruction patients (P < 0.001).