International Journal of Pediatric Otorhinolaryngology
Tracheotomy in children: Evolution in indications
Introduction
The aim of this study was to evaluate the evolution of tracheotomy indications in children over the past decades.
Tracheotomy is relatively frequently performed in a pediatric ENT tertiary setting. During the period study, laryngotracheobronchitis and epiglottitis were the usual indications for the tracheotomy in children [1], [2], [3].
Modern techniques in pediatric ICU have permitted a reduction in the number of tracheotomies performed in children in an acute setting [4], [5], [6], [7], [8]. But prolonged endotracheal intubation has increased the incidence of laryngotracheal stenosis [9], [10], [11].
As improvements have been made in medical management, more children with neurological diseases have been considered for tracheotomy. To evaluate the indications for tracheotomy in children, the medical records of all the children undergoing tracheotomy over a period of 6 years were reviewed.
Section snippets
Materials and methods
A retrospective study was carried out on all children undergoing tracheotomy in the Edouard Herriot University Hospital, Lyon, France, between 1996 and 2001.
Specific parameters included age, sex, indication, duration of intubation prior to tracheotomy, date of decannulation, endoscopies or other associated surgical interventions. In addition, deaths and complications were recorded.
Results
Forty-six children, 22 female and 24 male, had a tracheotomy performed in the Edouard Herriot University Hospital between January 1996 and December 2001. The children were classified into two categories:
- •
diseases requiring ventilator prolonged support 57% (N = 26),
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upper airway obstruction 43% (N = 20) Table 1.
Cases requiring ventilator pressure support included central respiratory failure (10 cases), craniovertebral trauma (eight cases), neuromuscular diseases (three cases), cardiovascular
Discussions
Although tracheotomy is a relative common procedure, the indications in children have changed in the last 30 years.
In the 1970s, the most common indication for tracheotomy was infection, comprising epiglottitis and laryngotracheobronchitis.
In this study, no case of tracheotomy for infection of the upper airway was recorded. Acute epiglottitis and laryngotracheobronchitis no longer represent an indication for tracheotomy due to introduction of endotracheal intubation in the 1970s and 1980s [12],
Conclusions
- (1)
The indications for tracheotomy in children have evolved.
- (2)
No tracheotomy was required in children with infectious causes of upper airway (epiglotittis and tracheobronchitis).
- (3)
Due to new treatments – endoscopy, surgery and non-invasive ventilation – the overall numbers of tracheotomy have reduced and decannulation is more rapid.
- (4)
The principal indications for tracheotomy for obstructive pathology of the upper airways are:
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failure of surgical treatment,
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laryngeal inflammation due to infectious causes
- •
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