Pediatric Tracheotomies: A 5-Year Experience In 152 Children

Year 2018, , 71 - 78, 31.08.2018

Fatih Alper Akcan , Yusuf Dündar Ahmet Uluat Derya Cebeci Mehmet Ali Sungur Nergis Salman İlhan Ünlü

https://doi.org/10.32448/entupdates.458961

Abstract

Objective:

To analyze the indications, complications, and outcomes of pediatric tracheotomies.

Material and methods:

All tracheotomies performed in a tertiary referral center between January 2011 and December 2015 were reviewed retrospectively. Demographic characteristics of patients, types of referral to hospital, tracheotomy indications, preoperative evaluation findings, surgical technique, postoperative care and complications, discharge and follow-up results were analyzed.

Results:

A total of 152 pediatric patients underwent tracheotomy at our hospital during this five year period. The median age of patients at the time of tracheotomy was 15.8 months, ranging from 24 days to 17 years. Of the 152 patients, 91 had neurological diseases, 38 had cardiopulmonary diseases, 14 had craniofacial abnormalities, seven had upper airway obstruction, and two underwent tracheostomy for trauma. Eleven (7.2%) patients experienced early complications, and 15 (9.8%) experienced late complications. Twenty (13.1%) patients were decannulated during the follow-up period. Unfortunately, 9 patients (5.9 %) died of primary disease and 3 patients (1.9 %) died of tracheostomy-related complications

Conclusions:

The majority of procedures were performed for diseases leading to prolonged mechanical ventilator support such as neurological and cardiopulmonary diseases. This study demostrates the importance of tracheotomy indications, which are the main predictors of decannulation rates. The other significant predictor is pulmonary complications that may cause permanent dependence of mechanical ventilator support as a result of pulmonary failure

Keywords

Pediatric tracheotom, tracheostom, decannulation, complication

References

• [1] Fraga JC, De Souza JCK, Kruel J. Pediatric tracheostomy. J Pediatr (Rio J) 2009;85:97-103.
• [3] Olszewski J, Miłoǹski J. History of tracheotomy. Otolaryngol Pol 2007;61:349-52.
• [4] Cummings, C.W., Flint P, Haugley B, Lund V, Niparko J, Robbins K, Regan T, Lesperance M. (2015). Cummings Otolaryngology:- Head and neck surgery. (pp. 95-103) Philedelphia:Elsevier/Saunders.
• [6] Carron JD, Derkay CS, Strope G, Nosonchuk JE, Darrow DH. Pediatric tracheotomies: changing indications and outcomes. Laryngoscope 2000;110:1099-104.
• [7] Funamura JL, Durbin-Johnson B, Tollefson TT, Harrison J, Senders CW. Pediatric tracheotomy: Indications and decannulation outcomes. Laryngoscope. 2014;124:1952-8.
• [8] Lewis CW, Carron JD, Perkins JA, Sie KC, Feudtner C. Tracheotomy in pediatric patients: a national perspective. Arch Otolaryngol Head Neck Surg 2003;129:523-9.
• [9] Jaryszak EM, Shah RK, Amling J, Peña MT. Pediatric tracheotomy wound complications: incidence and significance. Arch Otolaryngol Head Neck Surg 2011;137:363-6.
• [10] Ozmen S, Ozmen OA, Unal OF. Pediatric tracheotomies: a 37- year experience in 282 children. Int J Pediatr Otorhinolaryngol 2009;73:959-61.
• [11] Zenk J, Fyrmpas G, Zimmermann T, Koch M, Constantinidis J, Iro H. Tracheostomy in young patients: indications and long-term outcome. Eur Arch Otorhinolaryngol 2009;266:705-11.
• [12] Campisi P, Forte V. Pediatric tracheostomy. Seminars in Pediatric Surgery 2016;25:191-5.
• [13] Mahadevan M, Barber C, Salkeld L, Douglas G, Mills N. Pediatric tracheotomy: 17-year review. Int J Pediatr Otorhinolaryngol 2007;71:1829-35.
• [14] Kremer B, Botos-Kremer AI, Eckel HE, Schlondorff G. IndicaReferences tions, complications, and surgical techniques for pediatric tracheostomies—an update. J Pediatr Surg 2002;37:1556-62.
• [15] Ang AH, Chua DY, Pang KP, Tan HK. Pediatric tracheotomies in an Asian population: The Singapore experience. Otolaryngol Head Neck Surg 2005;133:246-50.
• [16] Erasmus CE, van Hulst K, Rotteveel JJ, Willemsen MA, Jongerius PH. Clinical practice: swallowing problems in cerebral palsy. Eur J Pediatr 2012;171:409-14.
• [17] Wilkinson DJ, Baikie G, Berkowitz RG, Reddihough DS. Awake upper airway obstruction in children with spastic quadriplegic cerebral palsy. J Paediatr. Child Health 2006;42:44-8.
• [18] Magardino TM, Tom LW. Surgical management of obstructive sleep apnea in children with cerebral palsy. Laryngoscope 1999;109:1611-5.
• [19] Kosko JR, Derkay CS. Uvulopalatopharyngoplasty: treatment of obstructive sleep apnea in neurologically impaired pediatric patients. Int J Pediatr Otorhinolaryngol 1995;32:241-6.
• [20] Cohen SR, Simms C, Burstein FD, Thomsen J. Alternatives to tracheostomy in infants and children with obstructive sleep apnea. J Pediatr Surg 1999;34:182-6.
• [21] Kontorinis G, Thevasagayam MS, Bateman ND. Airway obstruction in children with cerebral palsy: Need for tracheostomy? Int J Pediatr Otorhinolaryngol 2013;77:1647-50.
• [22] Weir KA,  McMahon S, Taylor S,  Chang AB. Oropharyngeal aspiration and silent aspiration in children. Chest 2011;140:589-97.
• [23] Weir K, McMahon S, Barry L, Ware R, Masters IB, Chang AB. Oropharyngeal aspiration and pneumonia in children. Pediatr Pulmonol 2007;42:1024-31.
• [24] Healy FM, Panitch HB. Pulmonary complications of pediatric neurological diseases. Pediatr Ann 2010;39:216-24.
• [25] Dodge NN. Cerebral palsy: medical aspects. Pediatr Clin North Am 2008;55: 1189-207
• [26] Seddon PC, Khan Y. Respiratory problems in children with neurological impairment. Arch Dis Child 2003;88:75-8.
• [27] Wilkesmann A, Ammann RA, Schildgen O, Eis-Hubinger AM, Muller A, Seidenberg J, et al. Hospitalized children with respiratory syncytial virüs infection and neuromuscular impairment face an increased risk of a complicated course. Pediatr Infect Dis J 2007;26:485-91.
• [28] Blanton L, Peacock G, Cox C, Jhung M, Finelli L, Moore C. Neurologic disorders among pediatric deaths associated with the 2009 pandemic influenza. Pediatrics 2012;130:390-6.
• [29] Millman AJ, Finelli L, Bramley AM, Peacock G, Williams DJ, Arnold SR, et al. Community-Acquired Pneumonia Hospitalization among Children with Neurologic Disorders. J Pediatr 2016;173:188-95.
• [30] Carr MM, Poje CP, Kingston L, Kielma D, Heard C. Complications in pediatric tracheostomies. Laryngoscope 2001;111:1925-8.
• [31] Epstein SK. Late complications of tracheostomy. Respir Care 2005;50:542-9.
• [32] Das P, Zhu H, Shah RK, Roberson DW, Berry J, Skinner ML. Tracheotomy-Related Catastrophic Events: Results of a National Survey. Laryngoscope 2012;122:30-7.
• [33] Fields AI, Rosenblatt A, Pollac MM, et al. Home care cost-effectiveness for respiratory technology-dependent children. Am J Dis Child  1991;145:729-33.
• [34] French LC, Wootten CT, Thomas RG, Neblett WW, Werkhaven JA, Cofer SA. Tracheotomy in the preschool population: indication and outcomes. Otolaryngol Head Neck Surg 2007;137:280-3.
• [35] de Trey L, Niedermann E, Ghelfi D, Gerber A, Gysin C. Pediatric tracheotomy: a 30-year experience. J Pediatr Surg 2013;48:1470-5.
• [36] Tantinikorn W, Alper CM, Bluestone CD, Casselbrant ML. Outcome in pediatric tracheotomy. Am J Otolaryngol 2003;24:131-7.
• [37] Leung R, Berkowitz RG. Decannulation and outcome following pediatric tracheostomy. Ann Otol Rhinol Laryngol 2005;114:743- 8.
• [38] Kost KM, Endoscopic percutaneous dilatational tracheotomy: a prospective evaluation of 500 consecutive cases. Laryngoscope 2005;115:1-30.
• [39] Scott CJ, Darowski M, Crabbe DC. Complications of percutaneous dilatational tracheostomy in children. Anaesthesia 1998;53:477-80.
• [40] Zawadzka-Glos L, Rawicz M, Chmielik M. Percutaneous tracheotomy in children. Int J Pediatr Otorhinolaryngol 2004;68:1387-90.
• [41] Toursarkissian B, Fowler CL, Zweng TN, et al. Percutaneous dilational tracheostomy in children and teenagers. J Pediatr Surg 1994;29:1421-4.
• [42] Gollu G, Ates U, Can OS, Kendirli T, Yagmurlu A, Cakmak M, et al. Percutaneous tracheotomy by Griggs technique under rigid bronchoscopic guidance is safe and feasible in children. J Pediatr Surg 2016;51:1635-9.