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. 2020 May;130(5):E375-E380.
doi: 10.1002/lary.28160. Epub 2019 Jun 28.

Pediatric tracheostomy: A large single-center experience

Jessica Roberts  1   2 , Jason Powell  1   2 , Jacob Begbie  2 , Gerard Siou  2 , Claire McLarnon  2 , Andrew Welch  2 , Michael McKean  3 , Mathew Thomas  1   3 , Anne-Marie Ebdon  3 , Samantha Moss  3 , Rachel S Agbeko  1   4 , Jonathan H Smith  5 , Malcolm Brodlie  1   3 , Christopher O'Brien  3 , Steven Powell  2
Affiliations

Pediatric tracheostomy: A large single-center experience

Jessica Roberts et al. Laryngoscope. 2020 May.

Abstract

Objectives: To describe the epidemiology, specifically the indications, complications, and outcomes, of pediatric tracheostomies performed in one tertiary referral unit.

Methods: Single-center retrospective cohort study of pediatric patients undergoing tracheostomy between May 2010 and May 2018 at the Newcastle upon Tyne Hospitals, United Kingdom.

Results: One hundred seventy-two pediatric tracheostomies were performed during the study period with a median age of 141 (interquartile range [IQR] 51-484) days. The most common primary indication was long-term ventilation (38.4%, 66 of 172), followed by weaning from ventilation in cardiac patients (22.1%, 38 of 172). Only 5.2% (9 of 172) of our cohort underwent tracheostomy for subglottic stenosis. The vast majority of tracheostomies were performed electively, with just 6.4% (11 of 172) performed as an emergency procedure. Early and late complication rates were 9.8% (15 of 153) and 40.0% (61 of 153), respectively. Tracheostomy decannulation was successful in 44.4% of children (68 of 153). The median duration the tracheostomy was in situ was 397 (IQR 106-708) days. All-cause mortality was 22.1% (38 of 172), with tracheostomy-related mortality at 1.2% (2 of 172).

Conclusion: We report one of the largest contemporary case series of pediatric tracheostomies. Present-day pediatric tracheostomy is primarily performed as an elective procedure in ventilated children under the age of 1 year. Pediatric tracheostomy should be considered as a long-term intervention in many children. Nevertheless, a large proportion of children are ultimately decannulated. It is important to acknowledge the significant morbidity associated with this intervention and the small-but-present risk of tracheostomy-related mortality.

Level of evidence: 4 Laryngoscope, 130:E375-E380, 2020.

Keywords: Pediatric tracheostomy; cardiothoracic transplant; long-term ventilation; pediatric airway.

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References

BIBLIOGRAPHY

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