title: Pediatric tracheotomy: are the indications changing?
abstract: OBJECTIVE
  The most common indications for tracheotomy in pediatric patients include upper airway obstruction, prolonged ventilator dependence, and hypotonia secondary to neurologic impairment. In this study we review the indications for tracheotomy within our patient population over the last 11 years.
  
  
  METHODS
  We conducted a retrospective chart review of consecutive patients undergoing tracheotomy at a tertiary care pediatric hospital from January 2000 to April 2011. We evaluated patient age, sex, pre-operative and post-operative diagnosis, and direct laryngoscopic and bronchoscopic findings. Patients were divided into six groups based on their indication for tracheotomy. In order to assess changing indications for tracheotomy over time, we compared an early (2000-2005) and a late (2006-2011) patient group.
  
  
  RESULTS
  We had complete data available on 158/165 patients (95.8%) who underwent tracheotomy from 2000 to 2011. There was no significant difference in mean age between the early and late groups (4.73 ± 6.0 years vs. 3.6 ± 5.5 years, p=0.26). There was a change in the most common indication for tracheotomy between the early and late groups, with upper airway obstruction becoming more common in the late group and significantly fewer patients undergoing tracheotomy for prolonged ventilation in the late group (33/76 (43%) vs. 23/82 (28%), p=0.05). More patients underwent bronchoscopy at the time of tracheotomy in the late group (52/82 (63%) vs. 28/76 (37%), p=<0.01).
  
  
  CONCLUSIONS
  A review of our pediatric tracheotomy experience demonstrated a change in the most common indication for tracheotomy between 2000 and 2011. In our patient population, there was a significant decline in the number of tracheotomies performed for prolonged intubation and an increasing number of patients who required tracheotomy for upper airway obstruction.
authors.affiliation: Division of Otolaryngology, University of Connecticut, United States. alawrason@gmail.com
authors.forename: Amy
authors.initials: A
authors.lastname: Lawrason
authors.forename: Katherine
authors.initials: K
authors.lastname: Kavanagh
mesh_terms: D000367:Age Factors; D000402:Airway Obstruction / Q000175:diagnosis* / Q000453:epidemiology / Q000601:surgery*; D001999:Bronchoscopy / Q000379:methods / Q000706:statistics & numerical data; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D005260:Female; D005500:Follow-Up Studies; D005544:Forecasting; D006801:Humans; D015994:Incidence; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D012189:Retrospective Studies; D018570:Risk Assessment; D012720:Severity of Illness Index; D012737:Sex Factors; D014139:Tracheostomy / Q000379:methods / Q000706:statistics & numerical data / Q000639:trends; D014140:Tracheotomy / Q000379:methods / Q000706:statistics & numerical data* / Q000639:trends; D016896:Treatment Outcome