Tracheotomy in children: Evolution in indications

doi:10.1016/j.ijporl.2005.05.028

International Journal of Pediatric Otorhinolaryngology

Volume 70, Issue 1, January 2006, Pages 115-119

https://doi.org/10.1016/j.ijporl.2005.05.028 Get rights and content

Summary

Objectives

To evaluate the evolution of indications for tracheostomy in children.

Methods

A retrospective review of 46 children undergoing tracheostomy between 1996 and 2001.

Results

The indications for tracheostomy were classified in two groups:

(1)
prolonged ventilator dependence (57%),
(2)
upper airway obstructions (43%).

The average age of the tracheostomy was 3 years and 8 months. This was higher in the first group (5.5 years). Decannulation was accomplished in 52%.

The indications for tracheostomy were evaluated and were found to decrease in frequency for upper airway obstructions. An increasing indication was for chronic disorders requiring prolonged ventilator dependence.

Complications occurred in 50% of children. Overall mortality was 13–2.7% directly related to the tracheostomy.

Conclusions

Evolving indication has been ventilator dependence. Upper airway obstruction as an indication has diminished in frequency, especially with the concomitant progress of endoscopic techniques.

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),
•
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:
- •
  failure of surgical treatment,
- •
  laryngeal inflammation due to infectious causes

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Pediatric tracheotomy: experience during the past decade
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Tracheotomy in infants and young children: the changing perspective – 1970–1985
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Tracheotomies: a 10-year experience in 319 children
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Pediatric tracheostomies: changing trends
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Cited by (47)

Tracheostomy practices in children on mechanical ventilation: a systematic review and meta-analysis
2022, Jornal de Pediatria
To evaluate current practices of tracheostomy in children regarding the ideal timing of tracheostomy placement, complications, indications, mortality, and success in decannulation.
The authors searched PubMed, Embase, Cochrane Library, Google Scholar, and complemented by manual search. The guidelines of PRISMA and MOOSE were applied. The quality of the included studies was evaluated with the Newcastle-Ottawa Scale. Information extracted included patients’ characteristics, outcomes, time to tracheostomy, and associated complications. Odds ratios (ORs) with 95% CIs were computed using the Mantel-Haenszel method.
Sixty-six articles were included in the qualitative analysis, and 8 were included in the meta-analysis about timing for tracheostomy placement. The risk ratio for “death in hospital outcome” did not show any benefit from performing a tracheostomy before or after 14 days of mechanical ventilation (p = 0.49). The early tracheostomy before 14 days had a great impact on the days of mechanical ventilation (-26 days in mean difference, p < 0.00001). The authors also found a great reduction in hospital length of stay (-31.4 days, p < 0.008). For the days in PICU, the mean reduction was of 14.7 days (p < 0.007).
The meta-analysis suggests that tracheostomy performed in the first 14 days of ventilation can reduce the time spent on the ventilator, and the length of stay in the hospital, with no effect on mortality. The decision to perform a tracheostomy early or late may be more dependent on the baseline disease than on the time spent on ventilation .
Tracheostomy in the pediatric trisomy 21 population
2021, International Journal of Pediatric Otorhinolaryngology
Citation Excerpt :
In our cohort, 25% of tracheostomies were performed for CRF, which increases to 45% when including the Both cohort. These figures are similar to, but on the high end of, reported rates for the general population, which range between 12% and 45% [10–17,21,22]. While AO and CRF were the most common indications for tracheostomy in our cohort, other common indications were notably absent.
Tracheostomy in children is often performed to alleviate airway obstruction (AO) or to facilitate long-term ventilator support due to respiratory failure of various etiologies, such as heart failure, and postoperative respiratory failure. Although many of these pathologies are common among trisomy 21 patients, tracheostomy rates among this population have not previously been reported. The aim of our study was to determine the incidence of trisomy 21 patients undergoing tracheostomy. Secondary objectives include decannulation rates and mortality associated with tracheostomy.
A retrospective cohort study was conducted on pediatric trisomy 21 patients undergoing tracheostomy between 2004 and 2013.
Twenty patients underwent tracheostomy at a median age of 7.1 months (interquartile range [IQR] = 3.5,21.3). The estimated incidence of tracheostomy in trisomy 21 patients among our tracheostomy population was 1.7% (20/1173) over 10 years. The most common indications were airway obstruction (AO) (55%), cardiac/pulmonary respiratory failure (CRF) (25%), or both (20%). Overall mortality was 30%, much lower among AO patients (9%) than CRF (40%) or both (60%), (P = 0.029). Nine patients (45%) were successfully decannulated, with median duration of cannulation of 2.2 years (IQR = 1.7,3).
This study suggests a rate of tracheostomy in the pediatric trisomy 21 population approximately 3 times that of the general pediatric population. Over half in this cohort underwent tracheostomy for isolated AO, while the general pediatric tracheostomy population demonstrates a much higher prevalence of prematurity-related CRF. Overall mortality rate and decannulation rate approximated that of the general pediatric tracheostomy population, although outcomes were significantly poorer among patients trisomy 21 patients undergoing tracheostomy for CRF.
Tracheostomy, respiratory support, and developmental outcomes in neonates with severe lung diseases: Retrospective study in one center
2020, Archives de Pediatrie
Pediatric tracheostomy has evolved significantly in the past few decades and the optimal timing to perform it in children with respiratory assistance is still debated. The objective of this study was to describe the indications, timing, complications, and outcomes of infants on respiratory support who had a tracheostomy in a tertiary pediatric intensive care unit (PICU).
All children younger than 18 months of corrected age requiring respiratory support for at least 1 week and who had a tracheostomy between January 2005 and December 2015 were included. Their demographic and clinical data and their outcomes at 24 months of corrected age were collected and analyzed after approval from the CHU Sainte-Justine ethics committee.
During the study period, 18 children (14 preterm infants, 4 polymalformative syndromes, and 2 diaphragmatic hernias) were included. The median corrected age at tracheostomy was 97 days (0–289 days) and 94.4% were elective. The indications for tracheostomy were ventilation for more than 7 days with (61.1%) or without (38.9%) orolaryngotracheal anomaly. The median number of consultants involved per patient was 16 consultants (10–23 consultants). The median hospital length of stay was 122 days (8–365 days) before tracheostomy and 235 days (22–891 days) after tracheostomy. The median invasive ventilation time was 68 days (8–168 days) before tracheostomy and 64 days (5–982 days) after tracheostomy. In terms of complications, there were nine cases of tracheitis and five cases of tracheal granulomas. At 24 months of corrected age, 17 of 18 children survived, one of/17 was still hospitalized, three of 17 were decannulated, three of 17 received respiratory support via their tracheostomy, 11 of 17 were fed with a gastrostomy, and all had neurodevelopmental delay.
Tracheostomy in infants requiring at least 1 week of ventilation is performed for complex cases and is favored for orolaryngotracheal anomalies. Clinicians should anticipate the need for developmental care in this population.
Pediatric tracheocutaneous fistula closure following tracheostomy decannulation
2019, International Journal of Pediatric Otorhinolaryngology
To determine the frequency and risk factors that lead to the development of persistent TCF (tracheocutaneous fistula) formation in children following tracheostomy decannulation at our institution.
A retrospective chart review of all pediatric patients at Children's Hospital Colorado who underwent tracheostomy decannulation and were being followed between January 1, 2007 and December 31, 2013. TCF was defined as a persistent fistula six months following decannulation. We determined patient demographics, age at tracheotomy, primary indication for tracheotomy, tracheostomy-tube size, medical comorbidities, age at decannulation, date of TCF closure, and method of TCF closure.
One hundred twenty-nine patients ranging from 51 days to 19 years of age underwent tracheostomy decannulation. 63 (49%) patients underwent surgical closure of TCF. Compared to those with spontaneous closure by multivariable analysis, those with surgical closure were younger at tracheostomy placement (p = 0.0002), had a tracheostomy for a longer duration (p = 0.0025), and were diagnosed with tracheobronchomalacia (p = 0.0051). The likelihood of spontaneous closure decreased over time. Tracheostomy tube internal diameter correlated with age (R = 0.64, p < 0.0001).
Approximately 50% of pediatric tracheostomy stoma sites will close spontaneously. Development of a persistent TCF was associated with younger age at placement, longer duration of tracheostomy, and the presence of tracheobronchomalacia. These observations may help clinicians anticipate outcomes following tracheostomy decannulation in children.
Tracheostomy in children: a ten-year experience from a tertiary center in southern Brazil
2017, Brazilian Journal of Otorhinolaryngology
Children may require tracheostomy due to many different health conditions. Over the last 40 years, indications of tracheostomy have endorsed substantial modifications.
To evaluate pediatric patients warranted tracheostomy at our Hospital, in regard to their indications, associated comorbidities, complications and decannulation rates.
Retrospective study concerning patients under 18 years of age undergoing tracheostomy in a tertiary health care center, from January 2006 to November 2015.
123 children required a tracheostomy after ENT evaluation during the study period. A proportion of 63% was male, and 56% was under one year of age. Glossoptosis was the most common indication (30%), followed by subglottic stenosis (16%) and pharyngomalacia (11%). The mortality rate was 31%. By the end of this review, 35 children (28.4%) had been decannulated, and the fewer the number of comorbidities, the greater the decannulation rate (0.77 ± 0.84 vs. 1.7 ± 1.00 comorbidities; p < 0.001).
Tracheostomy in children is a relatively frequent procedure at our hospital. The most common indications are glossoptosis and subglottic stenosis. A high mortality rate was found, potentially substantiated by the high number of critical care patients with chronic neurological conditions in this cohort. Our decannulation rate is slightly below other series, probably because of the greater amount of patients with comorbidities.
As crianças podem necessitar de traqueostomia devido a diferentes problemas de saúde. Ao longo dos últimos 40 anos, as indicações de traqueostomia passaram por mudanças substanciais.
Avaliar pacientes pediátricos com traqueostomia no nosso Hospital, no que diz respeito às suas indicações, comorbidades associadas, complicações e taxas de decanulação.
Estudo retrospectivo de pacientes com menos de 18 anos de idade submetidos a traqueostomia em um centro de saúde terciário, de janeiro de 2006 a novembro de 2015.
123 crianças precisaram de uma traqueostomia após avaliação otorrinolaringológica durante o período do estudo. Do total, 63% era do sexo masculino e 56% menores de um ano. Glossoptose foi a indicação mais comum (30%), seguida por estenose subglótica (16%) e faringomalácia (11%). A taxa de mortalidade foi de 31%. Até o fim deste artigo, 35 crianças (28,4%) haviam sido decanuladas e quanto menor o número de comorbidades, maior foi a taxa de decanulação (0,77 ± 0,84 vs. 1,7 ± 1,00 comorbidades; p < 0,001).
A traqueostomia em crianças é um procedimento relativamente frequente em nosso hospital. As indicações mais comuns são glossoptose e estenose subglótica. Uma alta taxa de mortalidade foi encontrada, potencialmente comprovada pelo elevado número de pacientes críticos com condições neurológicas crônicas nessa coorte. Nossa taxa de decanulação está ligeiramente abaixo de outras séries, provavelmente por causa da maior quantidade de pacientes com comorbidades.
First Clinical Consensus and National Recommendations on Tracheostomized Children of the Brazilian Academy of Pediatric Otorhinolaryngology (ABOPe) and Brazilian Society of Pediatrics (SBP)
2017, Brazilian Journal of Otorhinolaryngology
Tracheostomy is a procedure that can be performed in any age group, including children under 1 year of age. Unfortunately health professionals in Brazil have great difficulty dealing with this condition due to the lack of standard care orientation.
This clinical consensus by Academia Brasileira de Otorrinolaringologia Pediátrica (ABOPe) and Sociedade Brasileira de Pediatria (SBP) aims to generate national recommendations on the care concerning tracheostomized children.
A group of experts experienced in pediatric tracheostomy (otorhinolaryngologists, intensive care pediatricians, endoscopists, and pediatric pulmonologists) were selected, taking into account the different regions of Brazil and following inclusion and exclusion criteria.
The results generated from this document were based on the agreement of the majority of participants regarding the indications, type of cannula, surgical techniques, care, and general guidelines and decannulation.
These guidelines can be used as directives for a wide range of health professionals across the country that deal with tracheostomized children.
A traqueostomia é um procedimento que pode ser realizado em qualquer faixa etária, inclusive em crianças abaixo de um ano. Infelizmente no Brasil existe uma enorme dificuldade dos profissionais de saúde em lidar com esta condição e uma falta de padronização dos cuidados.
Este consenso clínico realizado pela Academia Brasileira de Otorrinolaringologia Pediátrica (ABOPe) e Sociedade Brasileira de Pediatria (SBP) tem como objetivo gerar recomendações nacionais sobre os cuidados e condutas diante das crianças traqueostomizadas.
Foram selecionados um grupo de especialistas com experiência em traqueostomia na infância (otorrinolaringologistas, pediatras intensivistas, endoscopistas, pneumopediatras) que tivessem comprovada atuação prática no assunto, e que também contemplassem as diversas regiões do Brasil, de acordo com os critérios de inclusão e exclusão.
Os resultados gerados neste documento foram a partir da concordância da maioria dos participantes em relação as indicações, tipo de cânula, técnicas cirúrgicas, cuidados e orientações gerais e decanulação.
Estas diretrizes poderão servir como norteadoras para os mais diversos profissionais de saúde em todo país que lidam com as dificuldades das crianças traqueostomizadas.

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Tracheotomy in children: Evolution in indications

Summary

Objectives

Methods

Results

Conclusions

Introduction

Section snippets

Materials and methods

Results

Discussions

Conclusions

Int. J. Pediatr. Otorhinolaryngol.

Int. J. Pediatr. Otorhinolaryngol.

Int. J. Pediatr. Otorhinolaryngol.

Int. J. Pediatr. Otorhinolaryngol.

Int. J. Pediatr. Otorhinolaryngol.

Pediatric tracheotomy: experience during the past decade

Ann. Otol. Rhinol. Laryngol.

Tracheotomy in infants and young children: the changing perspective – 1970–1985

Laryngoscope

Tracheotomies: a 10-year experience in 319 children

Ann. Otol. Rhinol. Laryngol.

Pediatric tracheostomies: changing trends

J. Otolaryngol.