Pediatric tracheostomy: A large single‐center experience. (28th June 2019)

• Record Type: Journal Article
• Authors: Roberts, Jessica; Powell, Jason; Begbie, Jacob; Siou, Gerard; McLarnon, Claire; Welch, Andrew; McKean, Michael; Thomas, Mathew; Ebdon, Anne‐Marie; Moss, Samantha; Agbeko, Rachel S.; Smith, Jonathan H.; Brodlie, Malcolm; O'Brien, Christopher; Powell, Steven
• Is Part Of: Laryngoscope. Volume 130:Number 5(2020)
• Page Start: E375
• Page End: E380
• Publication Date: 2019-06-28
• Subjects: Pediatric tracheostomy -- pediatric airway -- cardiothoracic transplant -- long‐term ventilation; Otolaryngology -- Periodicals; 617.51005
• DOI: 10.1002/lary.28160
• Languages: English
• ISSNs: 0023-852X

Abstract

Abstract : Objectives: To describe the epidemiology, specifically the indications, complications, and outcomes, of pediatric tracheostomies performed in one tertiary referral unit. Methods: Single‐center retrospective cohort study of pediatric patients undergoing tracheostomy between May 2010 and May 2018 at the Newcastle upon Tyne Hospitals, United Kingdom. Results: One hundred seventy‐two pediatric tracheostomies were performed during the study period with a median age of 141 (interquartile range [IQR] 51–484) days. The most common primary indication was long‐term ventilation (38.4%, 66 of 172), followed by weaning from ventilation in cardiac patients (22.1%, 38 of 172). Only 5.2% (9 of 172) of our cohort underwent tracheostomy for subglottic stenosis. The vast majority of tracheostomies were performed electively, with just 6.4% (11 of 172) performed as an emergency procedure. Early and late complication rates were 9.8% (15 of 153) and 40.0% (61 of 153), respectively. Tracheostomy decannulation was successful in 44.4% of children (68 of 153). The median duration the tracheostomy was in situ was 397 (IQR 106–708) days. All‐cause mortality was 22.1% (38 of 172), with tracheostomy‐related mortality at 1.2% (2 of 172). Conclusion: We report one of the largest contemporary case series of pediatric tracheostomies. Present‐day pediatric tracheostomy is primarily performed as an elective procedure in ventilated children under the age of 1 year. Pediatric tracheostomy should be considered as a long‐term intervention in many children. Nevertheless, a large proportion of children are ultimately decannulated. It is important to acknowledge the significant morbidity associated with this intervention and the small‐but‐present risk of tracheostomy‐related mortality. Level of Evidence: 4 Laryngoscope, 130:E375–E380, 2020