Pediatric Tracheostomy: A retrospective study focused on patient’s characteristics and outcomes
Esra Ozcakir1
, Fatih Celik2, Sermin Eminoglu3(0000-0001-5741-960), Arzu Oto3, Ipek Guney Varal5(0000-0002-3298-66X), Mete Kaya1
1University of Health Sciences, Bursa Medical Faculty, Department of Pediatric Surgery
2Uludag University, Medical Faculty, Department of Pediatric Surgery
3University of Health Sciences, Bursa Medical Faculty, Department of Anesthesia and Reanimation
4University of Health Sciences, Bursa Medical Faculty, Department of Pediatrics, Division of Pediatric Critical Care
5University of Health Sciences, Bursa Medical Faculty, Department of Pediatrics, Division of Neonatology
Keywords: Tracheostomy, pediatric patients, intubation, tracheostomy cannula
Abstract
Objective: To assess the patient characteristics, indications, additional interventions, and outcomes associated with surgical tracheostomy in children managed multidisciplinary pediatric and neonatal intensive care unit (PICU, NICU) following for 3 years.
Methods: We performed a retrospective, descriptive study within 106 pediatric tracheostomy procedures (TP) in a tertiary pediatric referral center. Inclusion criteria were age range 0-17 years and elective TPs performed by pediatric surgeons between January 2018 and January 2021. The patients existing tracheostomy or undergoing emergency TPs were excluded. The medical records and follow-up findings of pediatric patients with TP were retrospectively analyzed. The children's characteristics, indications and methods of tracheostomy, additional interventions, complications, and outcomes were recorded.
Results: Eighty-four children (45 female, 39 male) met inclusion criteria with a median age of 3.59 years (10 days–17 years). A tracheostomy was performed to address the complications arising from prolonged mechanical ventilation in 74 children (88%) or upper airway obstruction in 10 children (12%). All interventions were performed under general anesthesia in the operating theatre. The mean length of stay (LOS) was 35.06 (13–74 days) days. There were 31 (37%) anti-reflux and gastrostomy procedures performed as an additional intervention in cases with a tracheostomy. Early complications (11%) were noted in nine patients and included hemorrhage (n:3), accidental decannulation (n:4), and pneumothorax (n:2). Delayed complications (4%) included granulation tissue (n:1) and stenosis of tracheotomy (n:2). Fifteen patients (18%) died within an average of 33 days (2–76 days) after the tracheostomy procedure due to underlying diseases. Four patients were decannulated until now.
Conclusion: The under 1-year old patients predominated our series, and prolonged ventilation dependency accounted for the largest number of indications for tracheostomy, followed by airway obstruction causes. The pediatric tracheostomy is a safe and effective procedure that has a significant improvement in airway symptoms, a marked reduction in the LOS, and a low complication rate in all age groups.
Cite as: Ozcakir E, Celik F, Eminoglu S, Oto A, Guney Varal İ, Kaya K. Pediatric tracheostomy: A retrospective study focused on patient’s characteristics and outcomes. Coc Cer Derg/Turkish J Ped Surg 2022; 36(1); 15-23. doi: 10.29228/JTAPS.54982