Elsevier

Journal of Pediatric Surgery

Volume 37, Issue 11, November 2002, Pages 1556-1562
Journal of Pediatric Surgery

Indications, complications, and surgical techniques for pediatric tracheostomies—An update

https://doi.org/10.1053/jpsu.2002.36184Get rights and content

Abstract

Background: With the decrease of life-threatening obstructive upper airway infections and the ongoing improvement of intensive care medicine, the role of tracheostomy in children has been changing considerably, until now. The aim of this study was to establish data regarding indications, complications, and techniques of pediatric tracheostomy, which would reflect the current state of science. Methods: The authors analyzed the international literature as well as their own experience with 25 children less than 6 years of age who were operated on between 1980 and 1996. Results: Literature proved to be very heterogeneous in terms of terminology, patient groups, operation techniques, indications, and complications. Within the past decades, long-term intubation and congenital anomalies of the upper respiratory tract have become increasingly prevalent, whereas inflammatory diseases were less and less an indication for tracheostomy. Endotracheal intubation as an alternative has resulted in less frequent tracheostomies in general. Today, children can be ventilated for months without considerable complications. However, individual, clinical, and fiberoptical controls are necessary. Tracheostomy-related complications have not changed significantly. Fatalities are mostly caused by the underlying disease. The most frequent causes of tracheostomy-related death are cannula obstruction and accidental decannulation. The most frequent early complications are pneumomediastinum, pneumothorax, wound complications, and bleedings. Subsequent complications most often are granulations and tracheal stenosis. Conclusions: The authors' research agreed widely with that in the literature. However, no tracheostomy-related death occurred. Possibly, this was because of their operative technique. In the opinion of the authors, establishing a cartilage window facilitates cannula exchange and reduces the risk of a fatal accidental decannulation. J Pediatr Surg 37:1556-1562. Copyright 2002, Elsevier Science (USA). All rights reserved.

Section snippets

Materials and methods

We evaluated the international literature for pediatric tracheostomy since 1971, using 49 publications for pediatric tracheostomy in general and 38 studies regarding indications and complications of tracheostomy in children. A literature search was done with the data banks of MEDLINE and DIMDI; search terms were pediatric, tracheotomy, tracheostomy, indication, complication, and outcome. Each publication was evaluated according to its age spread, indications, complications and—if

Definition of the term child in regard to tracheostomy

The definition of child according to tracheostomy includes patients less than 3 years old1 to younger than 19 years of age.2 Some investigators have researched tracheostomy in premature babies and newborns only,3, 4, 5, 6 whereas others dealt exclusively with tracheostomy in infants. The age limit in our study was 6 years, which was determined by consideration of the Law of Hagen-Poiseuille: v = r4/8l × (p1-p2) × t (V = volume, r = radius, l = length, p = pressure, and t = time), which states

Discussion

The aim of this study was to establish data regarding indications, techniques, and complications of pediatric tracheostomy, which would reflect the current state of science. Therefore, the international literature from the past decades was analyzed and compared with our own experience with 25 tracheostomies performed in children younger than 6 years. Literature research proved to be very difficult caused by the heterogeneity of the different studies. Comparability was limited by differences in

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    Address reprint requests to Bernd Kremer, MD, PhD, Department of Otorhinolaryngology, Head and Neck Surgery, University Hospital Maastricht, PO Box 5800, NL-6202 AZ Maastricht, The Netherlands.

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