Current trends in paediatric tracheostomies.
OBJECTIVE
In the 1970s, the most common indication for tracheostomy in children was acute inflammatory airway obstruction. Modern neonatal intensive care units have turned long-term intubation into an alternative to tracheostomy. Long-term intubation itself has become the most important indication for tracheostomy combined with subglottic stenosis.


METHODS
Retrospective analysis in a tertiary referral center. A total of 38 patients who underwent tracheostomy for respiratory failure and upper airway obstruction from 1 November 1998 to 30 November 2004.


RESULTS
Total complication rate was 42.1%. In children under 1 year of age the complication rate was 47.4%, in children over 1 year the complication rate was 26.3%. Decannulation was attempted in 12 patients with a cannulation time of 22 months.


CONCLUSIONS
Long-term intubation and its sequelae have now become one of the most important indication for tracheostomy. The change of indication has also entailed a decrease of the average age of children who require tracheostomy. A longer period before decannulation and a lower average age have changed the complication rate of tracheostomy in paediatric patients.
Parrilla
Claudio
C
Institute of Otolaryngology, Sacro Cuore Catholic University, Rome, Italy. claudioparrilla@yahoo.com
Scarano
Emanuele
E
Guidi
Maria Lavinia
ML
Galli
Jacopo
J
Paludetti
Gaetano
G
D000208:Acute Disease; D000402:Airway Obstruction / Q000453:epidemiology* / Q000601:surgery*; D005260:Female; D006304:Health Status; D006801:Humans; D007223:Infant; D007363:Intensive Care Units, Neonatal / Q000706:statistics & numerical data; D008297:Male; D010372:Pediatrics / Q000706:statistics & numerical data / Q000639:trends*; D011183:Postoperative Complications / Q000453:epidemiology; D012189:Retrospective Studies; D014139:Tracheostomy / Q000706:statistics & numerical data / Q000639:trends*