Indications for tracheostomy in children

Division of Paediatric Intensive Care and Pulmonology, University Children's Hospital Basel, Römergasse 8, CH-4059 Basel, Switzerland.
Paediatric respiratory reviews (Impact Factor: 2.2). 10/2006; 7(3):162-8. DOI: 10.1016/j.prrv.2006.06.004
Source: PubMed


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.

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    • "Children, particularly in cases after complex cardiac surgery, are prone to many respiratory complications, such as tracheal-bronchial malacia, vocal cord paralysis, external airway compression, and diaphragmatic paralysis. The development of such complications may hinder weaning and extubation and can lead to artificial airway dependence and chronic ventilation [3]. In pediatric patients, there is no clear and specific time indicated for moving the patient from an artificial trans-laryngeal airway to tracheostomy. "
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    ABSTRACT: Objective: To investigate the incidence, timing indications and outcome of tracheotomy in children who underwent cardiac surgeries. Methods: All pediatric cardiac patients (under 14 years of age) who underwent cardiac surgeries and required trache-otomy from November 2000 to November 2010 were reviewed. The data were collected and reviewed retrospectively. Results: Sixteen children underwent tracheotomy after cardiac surgery. Fifteen of these cases had surgery for con-genital heart disease, and one had surgery for an acquired rheumatic mitral valve disease. The mean ± SEMs of the durations of ventilation before and after tracheotomy were 60.4 ± 9.8 and 14.5 ± 4.79 days respectively (P value 0.0002). The means ± SEM of the lengths of ICU stay before and after tracheotomy were 63.31 ± 10.15 and 22 ± 5.4 days respectively (P value 0.0012). After the tracheotomy 12/16 patients (75%) were weaned from their ventilators and 10/16 were discharged from the PCICU. Six patients were discharged from the hospital and 3 were successfully decannulat-ed. The overall survival rate was 9/16 (56%). Conclusion: Tracheostomy shortens the duration of mechanical ventilation and facilitates discharge from the ICU. The mortality of tracheotomy patients is still significant but is mainly related to the primary cardiac disease.
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    ABSTRACT: Thuisbeademing bij kinderen kan op twee manieren worden toegepast: niet-invasief via een masker of invasief via een tracheacanule. De keuze tussen deze twee vormen van beademing wordt vooral bepaald door de duur van de beademing per dag, de hoest- en slikfunctie van de patiënt en eventuele anatomische beperkingen. In principe heeft niet-invasieve beademing de voorkeur. In dit artikel worden de indicaties, de complicaties, de specifieke kenmerken en de beperkingen van beide vormen van beademing besproken. Home mechanical ventilation in children can be delivered noninvasively through a mask or invasively through a tracheal cannula. The choice between these two is mainly determined by daily duration of ventilatory support, by the adequacy of airway protective reflexes (swallowing, coughing) and by the anatomical properties of the patient’s airways. For most patients noninvasive ventilation is the treatment of choice. In this paper, the indications, complications, specific features and limitations of both ways of home mechanical ventilation are discussed.
    Tijdschrift voor kindergeneeskunde 06/2009; 77(3):111-116. DOI:10.1007/BF03086372

  • New England Journal of Medicine 10/1962; 267(13):631-7. DOI:10.1056/NEJM196209272671301 · 55.87 Impact Factor
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