Tracheostomy in Critically Ill Children—Bypassing the Hurdle and Running into More!

Excerpt

The indications for tracheostomy in critically ill children are two-fold: emergent, to relieve upper airway obstruction and elective, for those requiring prolonged mechanical ventilation. In the latter group, tracheostomy tube (TT) has several advantages which include airway security, patient comfort, better oral hygiene and decreased work of breathing, ventilator-free days, ventilator-associated pneumonia, need for sedoanalgesia and increased ICU-free days and lower hospital cost [1]. Despite the outlined advantages, tracheostomy in children is technically challenging and associated with increased morbidity and mortality as compared to adults [2]. Furthermore, the timing of tracheostomy, unlike in adults, is highly variable in children [3, 4]. In a large retrospective study from the US involving 82 pediatric intensive care units (PICUs), an average 6.6% of pediatric admissions underwent tracheostomy between 4.3–30.4 d of ventilation [1]. In another study across 29 PICUs in the UK, the reported frequency of tracheostomy was 2% of all pediatric admissions, and the timing varied from 14 to 90 d after initiation of mechanical ventilation, mostly determined on an individual basis [5]. …