title: Tracheostomy in children: there is a place for acceptable risk.
abstract: BACKGROUND
  Tracheostomy in children remains controversial regarding the risk of complications.
  
  
  METHODS
  Forty-six trauma patients (35 male and 11 female, mean age = 6.8 years) were admitted to the intensive care unit between 1987 and 1991 with severe head injury plus coma. Tracheostomy was performed with standard technique after 5.9 days (range, 2-12 days) of intubation.
  
  
  RESULTS
  There were no deaths from tracheostomy, but six deaths resulted from severe head injury. One child was discharged with tracheostomy. The 39 survivors remained with tracheostomy 16.14 days (range, 4-71 days) in the intensive care unit. After cannula removal, 31 remained asymptomatic; 8 had respiratory distress: 2 were normal, 5 had endoscopic treatment for subglottic granulomas/stenosis from intubation, and 1 had tracheomalacia from tracheostomy. In 1997, the 18 patients located for follow-up were asymptomatic. At endoscopy, 8 were normal, 9 had subglottal granulomas from intubation, and 1 had 20% tracheal stenosis from tracheostomy.
  
  
  CONCLUSIONS
  Most complications after tracheostomy result from intubation. Tracheostomy has an acceptable risk in children with severe head injury who need prolonged ventilatory support.
authors.affiliation: Emergency Surgery Department ICU, Hospital das Clinicas, University of Sao Paulo School of Medicine, Sao Paulo, Brazil.
authors.forename: E P
authors.initials: EP
authors.lastname: Rocha
authors.forename: M D
authors.initials: MD
authors.lastname: Dias
authors.forename: F E
authors.initials: FE
authors.lastname: Szajmbok
authors.forename: B
authors.initials: B
authors.lastname: Fontes
authors.forename: R S
authors.initials: RS
authors.lastname: Poggetti
authors.forename: D
authors.initials: D
authors.lastname: Birolini
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D020207:Coma, Post-Head Injury / Q000150:complications / Q000628:therapy*; D006259:Craniocerebral Trauma / Q000150:complications / Q000628:therapy*; D004632:Emergency Medical Services; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D011183:Postoperative Complications; D012307:Risk Factors; D014139:Tracheostomy / Q000009:adverse effects*