Pediatric tracheostomy: A retrospective study focused on patient’s characteristics and outcomes

Abstract

Objective:To assess the patient characteristics, indications, additional interventions, and outcomes associated with surgical tracheostomy in children managed multidisciplinary pediatric and neonatal intensive care unit (PICU, NICU) following for 3 years. Methods: We performed a retrospective, descriptive study within 106 pediatric tracheostomy procedures (TP) in a tertiary pediatric referral center. Inclusion criteria were age range 0-17 years and elective TPs performed by pediatric surgeons between January 2018 and January 2021. The patients existing tracheostomy or undergoing emergency TPs were excluded. The medical records and follow-up findings of pediatric patients with TP were retrospectively analyzed. The children's characteristics, indications and methods of tracheostomy, additional interventions, complications, and outcomes were recorded. Results: Eighty-four children (45 female, 39 male) met inclusion criteria with a median age of 3.59 years (10 days–17 years). A tracheostomy was performed to address the complications arising from prolonged mechanical ventilation in 74 children (88%) or upper airway obstruction in 10 children (12%). All interventions were performed under general anesthesia in the operating theatre. The mean length of stay (LOS) was 35.06 (13–74 days) days. There were 31 (37%) anti-reflux and gastrostomy procedures performed as an additional intervention in cases with a tracheostomy. Early complications (11%) were noted in nine patients and included hemorrhage (n:3), accidental decannulation (n:4), and pneumothorax (n:2). Delayed complications (4%) included granulation tissue (n:1) and stenosis of tracheotomy (n:2). Fifteen patients (18%) died within an average of 33 days (2–76 days) after the tracheostomy procedure due to underlying diseases. Four patients were decannulated until now. Conclusion: The under 1-year old patients predominated our series, and prolonged ventilation dependency accounted for the largest number of indications for tracheostomy, followed by airway obstruction causes. The pediatric tracheostomy is a safe and effective procedure that has a significant improvement in airway symptoms, a marked reduction in the LOS, and a low complication rate in all age groups.