Tracheostomy in children: there is a place for acceptable risk.
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.
Rocha
E P
EP
Emergency Surgery Department ICU, Hospital das Clinicas, University of Sao Paulo School of Medicine, Sao Paulo, Brazil.
Dias
M D
MD
Szajmbok
F E
FE
Fontes
B
B
Poggetti
R S
RS
Birolini
D
D
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*