Outcome in pediatric tracheotomy.

OBJECTIVE

To investigate the outcome and related factors in pediatric tracheotomy.

DESIGN

Retrospective chart review.

SETTING

Tertiary pediatric academic hospital setting.

PATIENTS

The study included 181 children below the age of 18 years who underwent 185 tracheotomies between 1991 and 1995.

MAIN OUTCOMES AND MEASURES

Presenting symptoms and signs, indications, duration of follow-up, therapeutic and interval procedures, early and late complications, mortality, time to and success in decannulation.

RESULTS

There were 108 (59.7%) male patients and 73 (40.3%) female patients. The average age of the children at the time of tracheotomy was 3.8 +/- 5.3 years. The majority of the children were less than 1 year of age (n = 99, 54.7%). Airway obstruction was the leading indication for tracheotomy (59.6%), followed by ventilatory support (30.4%) and pulmonary toilet (9.9%). The average duration of follow-up was 931 +/- 790 days. There were no perioperative complications. Early postoperative complications were seen in 28 (15.5%) children including 12 (6.8%) major complications and 22 (12.2%) minor complications. Late complications were seen in 115 (63.5%) children, including 8 (4.4%) major complications and 107 (59.1%) minor complications. Overall mortality rate was 13.3%, but only 1 tracheotomy-related death was caused by tube displacement. Therapeutic procedures were performed in 43% of the children, including laryngotracheal reconstruction (13%), laser excision of the lesion (5%), and supraglottoplasty (3.9%). Decannulation was accomplished in 116 (64.1%) of the children with an average of 365 +/- 388 days with tracheotomy.

CONCLUSION

Tracheotomy is relatively safe in the pediatric population. Decannulation may be possible relatively quickly with resolution of the underlying problem.