title: Tracheostomy in children.
abstract: We reviewed the records of 108 patients who had a tracheostomy performed over a 10-year period from July 1979 to April 1989. Median age at tracheostomy was 6 months (1 week-15 years). Indications for surgery were acquired subglottic stenosis (31.4%), bilateral vocal cord paralysis (22.2%), congenital airway malformations (22.2%) and tumours (11.1%). No epiglottis and no emergency situation had to be managed by tracheostomy. Operation was uneventful in all, but 8 patients (7.4%) developed a pneumothorax in the postoperative period. Twenty-one (19.5%) had severe complications during the cannulation period (tube obstruction in 11 patients with cardiorespiratory arrest in 4; dislocation of the tube in 6 patients). Fifteen patients (13.8%) had severe complications after decannulation (2 had a cardiorespiratory arrest); all 15 had to be recannulated. At the end of the study period 85 patients (78.7%) were successfully decannulated with a median period of tracheostomy of 486 days (8 days-6.6 years). The median hospital stay was 159 days (13 days-2.7 years). All patients could be discharged. Eight patients (7.4%) died but no death was related to tracheostomy. In summary the mortality rate is lower than reported in previous reviews and tracheostomy is a safe operation even in small children but cannula-related complications may lead to life-threatening events. The management of tracheostomized small children and infants in a highly staffed and monitored intensive care unit has allowed better handling of complications and has resulted in a reduction in cannula-related deaths.
authors.affiliation: Intensive Care Unit, University Children's Hospital, Zürich, Switzerland.
authors.forename: B
authors.initials: B
authors.lastname: Simma
authors.forename: D
authors.initials: D
authors.lastname: Spehler
authors.forename: R
authors.initials: R
authors.lastname: Burger
authors.forename: J
authors.initials: J
authors.lastname: Uehlinger
authors.forename: D
authors.initials: D
authors.lastname: Ghelfi
authors.forename: P
authors.initials: P
authors.lastname: Dangel
authors.forename: E
authors.initials: E
authors.lastname: Hof
authors.forename: S
authors.initials: S
authors.lastname: Fanconi
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D015278:Intensive Care Units, Pediatric; D012189:Retrospective Studies; D014139:Tracheostomy / Q000009:adverse effects* / Q000295:instrumentation