Tracheostomy--a 10-year experience from a UK pediatric surgical center.
OBJECTIVE
Tracheostomy in the pediatric population is associated with significant morbidity and mortality compared to adult practice. This study highlights evolving experience from a UK children's hospital.


METHODS
All children undergoing tracheostomy between 1995 and 2004 were identified. Indications, complications, and outcomes were evaluated.


RESULTS
Complete case records were reviewed for 112 children (age range, newborn-18 years). Indications included congenital birth defects--craniofacial disorders, esophageal atresia, laryngeal cleft, cystic hygroma, vascular malformations. Acquired upper airway pathology (15.5%) and malacia (12.1%) were additional criteria. Tracheostomy was also required for long-term ventilation in patients with neuromuscular disorders (12.1%) or ventilator dependency (26.7 %). Fifty-eight (50%) tracheostomies were created in infants <1 year. One hundred and nine were elective procedures with only 7 (6%) for emergency airway management. Morbidity included wound problems (14, 14.4%), tube displacement or obstruction (14, 14.4%), tracheocutaneous fistula (6, 6.2%), and pneumothorax (4, 4.1%). There were no acute hemorrhagic complications. Two children died after accidental tube displacement/obstruction.


CONCLUSIONS
Tracheostomy at this UK center is largely undertaken as an elective procedure. Children less than 1 year form an increasing patient group. Complications may be minimized by meticulous surgical technique and ensuring a comprehensive tracheostomy care program.
Corbett
Harriet J
HJ
Division of Child Health, The Royal Liverpool Children's Hospital, University of Liverpool, Eaton Road, Liverpool, L12 2AP, UK. hjcorbett@doctors.org.uk
Mann
Kulbir S
KS
Mitra
Indu
I
Jesudason
Edwin C
EC
Losty
Paul D
PD
Clarke
Raymond W
RW
D000293:Adolescent; D000402:Airway Obstruction / Q000209:etiology / Q000601:surgery*; D016009:Chi-Square Distribution; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D011183:Postoperative Complications; D012307:Risk Factors; D014139:Tracheostomy / Q000379:methods* / Q000706:statistics & numerical data; D016896:Treatment Outcome; D006113:United Kingdom