Tracheostomy in children: a population-based experience over 17 years

Pediatr Pulmonol. 2010 May;45(5):487-93. doi: 10.1002/ppul.21206.


Introduction: Tracheostomy is a lifesaving intervention with numerous complications.

Objectives: We describe the natural history of tracheostomy in children in a defined geographical area over a 17-year period. Our primary aim is to stress the need for a consensus on pediatric tracheostomy care.

Methods: This retrospective study reviewed the charts of 72 children who had tracheostomy between January 1990 and January 2007. Indications for the procedure were divided into 3 groups: (1) upper airway obstruction at a well-defined anatomic site (32 patients); (2) upper airway obstruction with a complex medical condition (24 patients); and (3) need for an access to the lower airway for long-term ventilation and pulmonary care with normal airway anatomy (16 patients).

Results: The most common indication for tracheostomy was upper airway obstruction due to subglottic stenosis (15 patients, 21%) or as part of a complex craniofacial syndrome (15 patients, 21%). The duration of intubation prior to tracheostomy and the duration of hospitalization after tracheostomy varied markedly. Tracheocutaneous fistulae complicated 15 of the 38 (37%) decannulated patients. Tracheostomy infection occurred in 90% of the patients and tracheal granulation in 56%. Eleven (15%) deaths occurred, 10 were due to the underlying medical illness and 1 to a mucous plug.

Conclusion: The complications of tracheostomy in children are substantial. Surveillance and prompt interventions are necessary to overcome life-threatening sequelae. A multidisciplinary (medical-surgical) approach provides better care for these highly vulnerable children. A consensus on pediatric tracheostomy care is needed.

MeSH terms

  • Adolescent
  • Airway Obstruction / surgery*
  • Alberta
  • Child
  • Child, Preschool
  • Female
  • Humans
  • Infant
  • Infant, Newborn
  • Length of Stay / statistics & numerical data
  • Male
  • Postoperative Complications / etiology
  • Postoperative Complications / microbiology
  • Respiratory Tract Fistula / etiology
  • Respiratory Tract Infections / etiology
  • Retrospective Studies
  • Tracheostomy / adverse effects
  • Tracheostomy / mortality
  • Tracheostomy / statistics & numerical data*