Pediatric Tracheotomy: 5-years of Experiences at a Tertiary Care Center

Year 2021, Volume: 31 Issue: 3, 66 - 69, 09.11.2021

Yaşar Kemal Duymaz , Aslı Şahin Yılmaz , Serap Şahin Önder Arzu Tarlanova Özgül Gergin Tinay

https://doi.org/10.26650/Tr-ENT.2021.994998

Abstract

Objective: To describe specific indications and complications of pediatric tracheostomies performed in our tertiary care children’s hospital between 2015 and 2020.

Materials and Methods: A retrospective study analyzing charts of pediatric tracheostomies utilizing the maturation suture technique was conducted. The review included patient data covering a 5-year period, commencing on the 1st of January 2015 through the 31st of May 2020.

Results: Fifty-five patients (33 females, 22 male) were included in the study. A tracheostomy was performed to address complications arising from prolonged ventilation in 48 children (87%) or upper airway obstruction in 7 children (13%).There was one intraoperative complication that resulted in death. There was one early postoperative complication (2%) (one child suffered accidental decannulation and the cannula was replaced without further incident). There were 7 late postoperative complications all featuring peristomal granulation tissue (13%). There were 16 deaths; however, only one resulted from the tracheostomy as outlined above. Eight patients (15%) were successfully decannulated. In 6 cases, the tracheostomy was spontaneously closed. Repair of tracheoesophageal fistula was required in two patients.

Conclusion: Currently, the tracheostomy is the preferred course of treatment. Though it can potentially lead to severe complications in children, instances of this occurring are rare. Therefore, a tracheostomy should be performed by a multidisciplinary team following predetermined rules in a specialized center.

Keywords

Pediatric tracheotomy, maturation suture technique, upper airway obstruction

References

• 1. Wetmore RF, Handler SD. Pediatric Tracheostomy Experience During the Past Decade. Ann Otol Rhinol Laryngol 1982;91(6 Pt 1):628-32. google scholar
• 2. Line WS, Hawkins DB, Kahlstrom EJ, MacLaughlin EF, Ensley JL. Tracheotomy in infants and young children: The changing perspective 1970-1985. Laryngoscope 1986;96(5):510-5. google scholar
• 3. Nassif C, Zielinski M, Francois M, Van Den Abbeele T. Tracheotomy in children: A series of 57 consecutive cases. Eur Ann Otorhinolaryngol Head Neck Dis 2015;132(6):321-5. google scholar
• 4. Can FK, Anıl AB, Anıl M, Gümüşsoy M, Çitlenbik H, Kandoğan T, et al. The outcomes of children with tracheostomy in a tertiary care pediatric intensive care unit in Turkey. Turk Pediatr Ars 2018;53(3):177-84. google scholar
• 5. Berry JG, Graham RJ, Roberson DW, Rhein L, Graham DA, Zhou J, et al. Patient characteristics associated with in-hospital mortality in children following tracheotomy. Arch Dis Child 2010;95(9):703-10. google scholar
• 6. Kremer B, Botos-Kremer AI, Eckel HE, Schlöndorff G. Indications, complications, and surgical techniques for pediatric tracheostomies - An update. J Pediatr Surg 2002;37(11):1556-62. google scholar
• 7. Gaudreau PA, Greenlick H, Dong T, Levy M, Hackett A, Preciado D, et al. Preventing complications of pediatric tracheostomy through standardized wound care and parent education. JAMA Otolaryngol Head Neck Surg 2016;142(10):966-71. google scholar
• 8. Ang AHC, Chua DYK, Pang KP, Tan HKK. Pediatric tracheotomies in an Asian population: The Singapore experience. Otolaryngol Head Neck Surg 2005;133(2):246-50. google scholar
• 9. De Trey L, Niedermann E, Ghelfi D, Gerber A, Gysin C. Pediatric tracheotomy: A 30-year experience. J Pediatr Surg 2013;48(7):1470-5. google scholar
• 10. Mahadevan M, Barber C, Salkeld L, Douglas G, Mills N. Pediatric tracheotomy: 17 year review. Int J Pediatr Otorhinolaryngol 2007;71(12):1829-35. google scholar
• 11. Hadfield PJ, Lloyd-Faulconbridge RV, Almeyda J, Albert DM, Martin Bailey C. The changing indications for paediatric tracheostomy. Int J Pediatr Otorhinolaryngol 2003;67(1):7-10. google scholar
• 12. Parrilla C, Scarano E, Guidi ML, Galli J, Paludetti G. Current trends in paediatric tracheostomies. Int J Pediatr Otorhinolaryngol 2007;71(10):1563-7. google scholar
• 13. Zenk J, Fyrmpas G, Zimmermann T, Koch M, Constantinidis J, Iro H. Tracheostomy in young patients: Indications and long-term outcome. Eur Arch Oto-Rhino-Laryngology 2009;266(5):705-11. google scholar 14. Chan T, Devaiah AK. Tracheostomy in Palliative Care. Otolaryngol Clin North Am 2009;42(1):133-41. google scholar
• 15. Gergin O, Adil EA, Kawai K, Watters K, Moritz E, Rahbar R. Indications of pediatric tracheostomy over the last 30 years: Has anything changed? Int J Pediatr Otorhinolaryngol 2016;87:144-7. google scholar
• 16. Özmen S, Özmen ÖA, Ünal ÖF. Pediatric tracheotomies: A 37-year experience in 282 children. Int J Pediatr Otorhinolaryngol 2009;73(7):959-61. google scholar
• 17. Walner DL, Loewen MS, Kimura RE. Neonatal subglottic stenosis -Incidence and trends. Laryngoscope 2001;111(1):48-51. google scholar
• 18. Mirabile L, Serio PP, Baggi RR, Couloigner VV. Endoscopic anterior cricoid split and balloon dilation in pediatric subglottic stenosis. Int J Pediatr Otorhinolaryngol 2010;74(12):1409-14. google scholar
• 19. Blanchard M, Leboulanger N, Thierry B, Blancal JP, Glynn F, Denoyelle F, et al. Management specificities of congenital laryngeal stenosis: External and endoscopic approaches. Laryngoscope 2014;124(4):1013-8. google scholar
• 20. Leaute-Labreze C, De La Roque ED, Hubiche T, Boralevi F, Thambo JB, Taîeb A. Propranolol for severe hemangiomas of infancy. N Engl J Med 2008;358(24):2649-51. google scholar
• 21. Fauroux B, Leboulanger N, Roger G, Denoyelle F, Picard A, Garabedian EN, et al. Noninvasive positive-pressure ventilation avoids recannulation and facilitates early weaning from tracheotomy in children. Pediatr Crit Care Med 2010;11(1):31-7. google scholar
• 22. Carr MM, Poje CP, Kingston L, Kielma D, Heard C. Complications in Pediatric Tracheostomies. Laryngoscope 2001;111(11):1925-8. google scholar
• 23. Atmaca S, Bayraktar C, Aşilioğlu N, Kalkan G, Özsoy Z. Pediatric tracheotomy: 3-year experience at a tertiary care center with 54 children. Turk J Pediatr 2011;53(5):537-40. google scholar
• 24. Colman KL, Mandell DL, Simons JP. Impact of stoma maturation on pediatric tracheostomy-related complications. Arch Otolaryngol -Head Neck Surg 2010;136(5):471-4. google scholar
• 25. Carron JD, Derkay CS, Strope GL, Nosonchuk JE, Darrow DH. Pediatric Tracheotomies: Changing Indications and Outcomes. Laryngoscope 2000;110(7):1099-104. google scholar
• 26. Simma B, Spehler D, Burger R, Uehlinger J, Ghelfi D, Dangel P, et al. Tracheostomy in children. Eur J Pediatr 1994;153(4):291-6. google scholar
• 27. Dursun O, Ozel D. Early and long-term outcome after tracheostomy in children. Pediatr Int 2011;53(2):202-6. google scholar
• 28. Zia S, Arshad M, Nazir Z, Awan S. Pediatric tracheostomy: Complications and role of home care in a developing country. Pediatr Surg Int 2010;26(3):269-73. google scholar
• 29. Karapinar B, Arslan MT, Ozcan C. Pediatric bedside tracheostomy in the pediatric intensive care unit: six-year experience. Turk J Pediatr 2008;50(4):366-72. google scholar