Tracheostomy in neurologically compromised paediatric patients: role of starplasty.
OBJECTIVE
Starplasty tracheostomy is an alternative to traditional tracheostomy. This paper reviews neurologically compromised paediatric patients with tracheostomies and discusses the role of starplasty tracheostomy.


METHODS
A retrospective review was conducted of paediatric patients with a neurological disorder who underwent tracheostomy between 1997 and 2011.


RESULTS
Forty-eight patients, with an average age of 7.3 years, were identified. The most common indications for tracheostomy were: ventilator dependence (39.6 per cent), an inability to tolerate secretions or recurrent aspiration pneumonia (33.3 per cent), and upper respiratory obstruction or hypotonia (12.5 per cent). The most common underlying neurological diagnosis was cerebral palsy. There were no early complications. Eighteen (43 per cent) of 42 patients with follow up experienced at least 1 delayed complication. Only 12 patients (28.6 per cent) were decannulated.


CONCLUSIONS
Patients with primary neurological diagnoses have low rates of decannulation; starplasty tracheostomy should be considered for these patients. Patients with seizure disorder or acute neurological injury tended to have a higher short-term decannulation rate; traditional tracheostomy is recommended in these patients.
Department of Otolaryngology,Wayne State University,Cleveland,Ohio,USA.
A
A
Gupta
Department of Pediatric Otolaryngology,Head and Neck Institute,Cleveland Clinic,Ohio,USA.
J
J
Stokken
Department of Pediatric Otolaryngology,Head and Neck Institute,Cleveland Clinic,Ohio,USA.
P
P
Krakovitz
Department of Otolaryngology,Ohio State University,Columbus,Ohio,USA.
P
P
Malhotra
Department of Pediatric Otolaryngology,Head and Neck Institute,Cleveland Clinic,Ohio,USA.
S
S
Anne
D000293:Adolescent; D060666:Airway Extubation; D000402:Airway Obstruction / Q000209:etiology / Q000601:surgery; D002547:Cerebral Palsy / Q000150:complications; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D017577:Cutaneous Fistula; D004827:Epilepsy; D005260:Female; D006801:Humans; D007223:Infant; D008297:Male; D009123:Muscle Hypotonia / Q000209:etiology / Q000601:surgery; D009422:Nervous System Diseases / Q000150:complications; D011015:Pneumonia, Aspiration / Q000209:etiology / Q000517:prevention & control; D012008:Recurrence; D012121:Respiration, Artificial / Q000379:methods; D012131:Respiratory Insufficiency / Q000209:etiology / Q000628:therapy*; D012189:Retrospective Studies; D014133:Tracheal Diseases; D014139:Tracheostomy / Q000379:methods*
Central Nervous System Diseases; Nervous System Diseases; Neurologic Manifestations; Pediatrics; Tracheostomy