Mortality in the pediatric patient with tracheotomy.

BACKGROUND

The mortality rate of children with tracheotomies is estimated to be between 11% and 40%, although the incidence of tracheotomy-related deaths is only between 0% and 3.4%. The purpose of this report was to analyze the mortality rate in children with tracheotomies.

METHODS

A review of the medical records of children at the University of Iowa Hospitals and Clinics who underwent tracheotomy over a 15-year period ending in 1989 was performed. Data were analyzed in 5-year time blocks (Block 1, 1975 to 1979; Block 2, 1980 to 1984; and Block 3, 1985 to 1989).

RESULTS

Fifty-two patients died with tracheotomy tubes in place. In 4 patients, the cause of death was tracheotomy related. Three of these patients were under 5 years of age and died secondary to tracheotomy tube displacement or obstruction; one patient, an 18-year-old, developed a fatal tracheotomy-related vascular hemorrhage. The average age of patients who died with tracheotomies decreased significantly from Block 1 to Block 3; in Block 3, mean age at the time of tracheotomy was significantly lower in patients who died than in patients who survived. A comorbidity score (CS) based on the number of airway diagnoses showed that higher CSs were associated with a poorer prognosis.

CONCLUSIONS

Mortality does not seem to be strongly related to the presence of the tracheotomy tube. Overall, two diagnostic groups were found to be independently associated with a poorer prognosis, ie, mechanical ventilation and pulmonary disease. Tracheotomies performed to provide airway access during other surgical procedures were associated with a better prognosis.