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Review
. 2021;9(2):188-199.
doi: 10.1007/s40136-021-00340-y. Epub 2021 Apr 15.

Update on Pediatric Tracheostomy: Indications, Technique, Education, and Decannulation

Colin Fuller  1   2 , Andre' M Wineland  1   2 , Gresham T Richter  1   2
Affiliations
Review

Update on Pediatric Tracheostomy: Indications, Technique, Education, and Decannulation

Colin Fuller et al. Curr Otorhinolaryngol Rep. 2021.

Abstract

Purpose of review: Tracheostomy in a child demands critical pre-operative evaluation, deliberate family education, competent surgical technique, and multidisciplinary post-operative care. The goals of pediatric tracheostomy are to establish a safe airway, optimize ventilation, and expedite discharge. Herein we provide an update regarding timing, surgical technique, complications, and decannulation, focusing on a longitudinal approach to pediatric tracheostomy care.

Recent findings: Pediatric tracheostomy is performed in approximately 0.2% of inpatient stays among tertiary pediatric hospitals. Mortality in children with tracheostomies ranges from 10-20% due to significant comorbidities in this population. Tracheostomy-specific mortality and complications are now rare. Recent global initiatives have aimed to optimize decision-making, lower surgical costs, reduce the length of intensive care, and eliminate perioperative wound complications. The safest road to tracheostomy decannulation in children remains to be both patient and provider dependent.

Summary: Recent literature provides guidance on safe, uncomplicated, and long-term tracheostomy care in children. Further research is needed to help standardize decannulation protocols.

Keywords: Bronchopulmonary Dysplasia; Clinical Reviews; Pediatrics; Trachea; Tracheostomy.

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Conflict of interest statement

Conflict of InterestGresham T. Richter is a Board Member of and has an equity stake in GDT Innovations, LLC. The other authors declare that they have no conflict of interest.

Figures

Fig. 1
Fig. 1
Proposed timeline for the care of the patient undergoing non-emergent tracheostomy, from the initial hospitalization through decannulation. Single asterisk “*: Transition off of mechanical ventilatory support is a process of variable length and can take years in younger patients with severe bronchopulmonary dysplasia. Double asterisk “**”: Pre-decannulation studies can include polysomnogram and/or upper and lower airway endoscopy
See this image and copyright information in PMC

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