title: Indications for tracheostomy in children.
abstract: Vaccination programs, improvements in material engineering and anaesthetic skills have dramatically reduced the number of emergency tracheostomies performed for acute upper airway obstruction. Today, the indication to tracheotomise a child is generally ruled by the anticipation of long-term (cardio)respiratory compromise due to chronic ventilatory or, more rarely, cardiac insufficiency, or by the presence of a fixed upper airway obstruction that is unlikely to resolve for a significant period of time. As many of the younger candidates for tracheostomy have complex medical conditions, the indication for this intervention is often complicated by ethical, funding and socio-economic concerns that necessitate a multidisciplinary approach. Unfortunately, these considerations are frequently not made until the first catastrophe has occurred, even in those patients in whom imminent cardiorespiratory failure has been foreseeable. Non-invasive ventilation via a face mask and newer developments such as the in-exsufflator device have gained importance as an alternative to tracheostomy in selected patients.
authors.affiliation: Division of Paediatric Intensive Care and Pulmonology, University Children's Hospital Basel, Römergasse 8, CH-4059 Basel, Switzerland. daniel.trachsel@ukbb.ch
authors.forename: Daniel
authors.initials: D
authors.lastname: Trachsel
authors.forename: Jürg
authors.initials: J
authors.lastname: Hammer
mesh_terms: D000402:Airway Obstruction / Q000628:therapy*; D002648:Child; D002675:Child, Preschool; D017408:Guidelines as Topic; D006801:Humans; D007223:Infant; D012121:Respiration, Artificial; D012131:Respiratory Insufficiency / Q000628:therapy; D014132:Trachea / Q000473:pathology; D014139:Tracheostomy / Q000379:methods* / Q000592:standards*