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: 2.22). 10/2006; 7(3):162-8. DOI: 10.1016/j.prrv.2006.06.004
Source: PubMed

ABSTRACT 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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