Scientific Online Resource System

Scripta Scientifica Medica

Tracheotomy in children

Dusan Milisavljevic, Milan Stankovic, Dragan Stojanov, Nikola Djordjevic

Abstract

Introduction

Tracheotomy is one of the most urgent procedures in medicine. It is an operative procedure that creates a surgical airway in the cervical trachea.

Aim

Tracheostomy refers to a surgical incision made into a trachea. Children are often considered “little people”, however, in medical sense, that is not completely true. The aim of our paper is to review the tracheostomy procedure in children.

Materials and Methods

In this paper, we analysed the tracheostomies in children performed in the Clinical Centre Niš (Serbia) in the five-year period from January 2015 to December 2019 inclusive. At our centre, all tracheostomies were solely performed by otolaryngologists.

Results

A total of 37 tracheotomies were performed in the studied period. There were 25 (67.6%) boys and 12 girls (32.4%). The main reason for this relatively low tracheostomy count in our study is because our practitioners are usually performing tracheostomies only in children that require urgent care. All chronic or complicated cases, if they are stable enough to transport, are referred to a higher specialised institution in Belgrade, Serbia.

The youngest was a newborn, not older than 1 hour, and the oldest was 17 years old. We divided them into groups according to the age. There were 5 (13.5%) neonates, 25 (67.6%) infants, 3 (8.1%) preschoolers, 2 (5.4%) school-aged children, and 2 (5.4%) adolescents. This is in concurrence with other studies, where authors reported that the highest number of tracheostomies (around 65–70%) were performed before 1 year of age.

In most cases, indication for tracheostomies were upper airway obstructions (n = 35, 94.6%). Prolonged orotracheal intubation (n = 1, 2.7%), and protective tracheostomy (n = 1, 2.7%) were the causes in the other two cases.

Conclusion

While researching the literature for this paper we found that there is little standardisation associated with tracheostomy, even though it is a procedure that is performed regularly all over the globe. There is evidence that there is a disparity in opinions not only among the practitioners in different countries, but in individual countries as well. With the increasing number of patients that require tracheostomy, we find that this topic should be addressed more carefully with the attempt to establish the best way of action for this procedure, and with that, lower the complication and mortality rates.


Keywords

tracheotomy; stridor; children

Full Text


References

Jackson C. Tracheotomy. Laryngoscope. 1909;19(4):285-329. doi:10.1288/00005537-190904000-00003.

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. doi: 10.1016/j.ijporl.2016.06.018.

Wood D, McShane P, Davis P. Tracheostomy in children admitted to paediatric intensive care. Arch Dis Child. 2012;97(10):866-9. doi: 10.1136/archdischild-2011-301494.

Schmidt AR, Weiss M, Engelhardt T. The paediatric airway: basic principles and current developments. Eur J Anaesthesiol. 2014;31(6):293-9. doi: 10.1097/EJA.0000000000000023.

Sands SA, Edwards BA, Kelly VJ, Davidson MR, Wilkinson MH, Berger PJ. A model analysis of arterial oxygen desaturation during apnea in preterm infants. PLoS Comput Biol. 2009;5(12):e1000588. doi: 10.1371/journal.pcbi.1000588.

Behl S, Watt JW. Prediction of tracheostomy tube size for paediatric long-term ventilation: an audit of children with spinal cord injury. Br J Anaesth. 2005;94(1):88-91. doi: 10.1093/bja/aeh296.

Douglas CM, Poole-Cowley J, Morrissey S, Kubba H, Clement WA, Wynne D. Paediatric tracheostomy-An 11 year experience at a Scottish paediatric tertiary referral centre. Int J Pediatr Otorhinolaryngol. 2015;79(10):1673-6. doi: 10.1016/j.ijporl.2015.07.022.

Pérez-Ruiz E, Caro P, Pérez-Frías J, Cols M, Barrio I, Torrent A, et al. Paediatric patients with a tracheostomy: a multicentre epidemiological study. Eur Respir J. 2012 Dec;40(6):1502-7. doi: 10.1183/09031936.00164611.

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(5):705–11. doi: 10.1007/s00405-008-0796-4.

Swift AC, Rogers JH. The changing indications for tracheostomy in children. J Laryngol Otol. 2007;101(12):1258–62. doi: 10.1017/s0022215100103627.

Ozmen S, Ozmen OA, Unal OF. Pediatric tracheotomies: a 37-year experience in 282 children. Int J Pediatr Otorhinolaryngol. 2009;73(7):959–61. doi: 10.1016/j.ijporl.2009.03.020.

Mahida JB, Asti L, Boss EF, Shah RK, Deans KJ, Minneci PC, et al. Tracheostomy placement in children younger than 2 years: 30-day outcomes using the National Surgical Quality Improvement Program Pediatric. JAMA Otolaryngol Head Neck Surg. 2016;142(3):241-6. doi: 10.1001/jamaoto.2015.3302.

Watters K, O’Neill M, Zhu H, Graham RJ, Hall M, Berry J. Two-year mortality, complications, and healthcare use in children with Medicaid following tracheostomy. Laryngoscope. 2016;126(11):2611–7. doi: 10.1002/lary.25972.

Mahadevan M, Barber C, Salkeld L, Douglas G, Mills N. Pediatric tracheotomy: 17-year review. Int J Pediatr Otorhinolaryngol. 2007;71(12):1829–35. doi: 10.1016/j.ijporl.2007.08.007.

Hall A, Bates J, Ifeacho S, Hartley B, Albert D, Jephson C, et al. Implementation of the TRACHE care bundle: improving safety in paediatric tracheostomy management. Arch Dis Child. 2017;102(6):563–5. doi: 10.1136/archdischild-2015-309661.

Al-Samri M, Mitchell I, Drummond DS, Bjornson C. Tracheostomy in children: a population-based experience over 17 years. Pediatr Pulmonol. 2010;45(5):487-93. doi: 10.1002/ppul.21206.

Ogilvie LN, Kozak JK, Chiu S, Adderley RJ, Kozak FK. Changes in pediatric tracheostomy 1982–2011: a Canadian tertiary children's hospital review. J Pediatr Surg. 2014;49(11):1549-53. doi: 10.1016/j.jpedsurg.2014.04.014.

Sioshansi PC, Balakrishnan K, Messner A, Sidell D. Pediatric tracheostomy practice patterns. Int J Pediatr Otorhinolaryngol. 2020;133:109982. doi: 10.1016/j.ijporl.2020.109982.




DOI: http://dx.doi.org/10.14748/ssm.v0i0.7405
Array
About The Authors

Dusan Milisavljevic
University ORL Clinic, Nis
Serbia

Milan Stankovic
University ORL Clinic, Nis
Serbia

Dragan Stojanov
University ORL Clinic, Nis
Serbia

Nikola Djordjevic
University ORL Clinic
Serbia

Font Size


|