Pediatric tracheostomy, its indications, outcome and need for family education: a study in a tertiary hospital
DOI:
https://doi.org/10.18203/2320-6012.ijrms20242609Keywords:
Standard protocol, Prolonged intubation, Paediatric tracheostomy, Family education, Airway obstruction, DecannulationAbstract
Background: Paediatric age group remains a challenging patient group for any kind of surgical intervention. Tracheostomy in this age group remains a challenge and its indications have evolved and shifted over the years.
Methods: A prospective study of 1 year period where patients below 18 years of age undergoing tracheostomy were studied and analyzed. Literature for existing protocols/guidelines were studied and implemented. Data was grouped according to age, gender, indications, contraindications, decannulation trends, complications and mortality outcome.
Results: 17 elective paediatric tracheostomies were done out of which 5 patients were female and 12 were male. In the <1 year age group there were 2 patients (12%), 4 (24%) in the 1-5 years group, 5 (29%) in 6-10 years and 6 (35%) in the 11-18 years age bracket. Commonest indication was prolonged intubation (41.18%) followed by upper airway obstruction (29.41%). Complications that we faced which was the most common was blockage of tube (46.67%), followed by decannulation difficulty (20%).
Conclusions: It is still a major challenge to standardize protocols for tracheostomy in paediatric age group as well as initiation of the care giver at home to follow adequate measures to manage children needing prolonged tracheostomy tube care.
References
Wetmore RF. Tracheostomy. In: Bluestone CD, Stool SE, Alpes CM, editors. Paediatric otolaryngology. 4th edition. Philadelphia: Saunders; 2003:1583-1598.
Primuharsa Putra SH, Wong CY, Hazim MY, Megat Shiraz MA, Goh BS. Paediatric tracheostomy in Hospital University Kebangsaan Malaysia - a changing trend. Med J Malaysia. 2006;61(2):209-13.
Hadfield PJ, Lloyd-Faulconbridge RV, Almeyda J, Albert DM, Bailey CM. The changing indications for paediatric tracheostomy. Int J Pediatr Otorhinolaryngol. 2003;67(1):7-10.
Gallagher TQ, Hartnick CJ. Pediatric tracheotomy. Adv Otorhinolaryngol. 2012;73:26-30.
Lanzenberger-Schragl E, Donner A, Grasl MC, Zimpfer M, Aloy A. Superimposed high-frequency jet ventilation for laryngeal and tracheal surgery. Arch Otolaryngol Head Neck Surg, 2000;126(1):40-4.
Watkinson J, Clarke R, editors. Scott-Brown's otorhinolaryngology and head and neck surgery: 3 volume set. CRC Press; 2018.
Doherty C, Neal R, English C, Cooke J, Atkinson D, Bates L, et al. Multidisciplinary guidelines for the management of paediatric tracheostomy emergencies. Anaesthesia. 2018;73(11):1400-17.
Wetmore RF. Tracheotomy. Bluestone CD, Stool SE, Alper CM, Arjmand EM, Casselbrant ML, Dohar JE, Yellow RF (eds). Pediatric Otolaryngology.
Watters Karen F. Tracheostomy in infants and children. Respir Care. 2017;62:799e825.
Midwinter KI, Carrie S, Bull PD. Paediatric tracheostomy: sheffield experience 1979e1999. J Laryngol Otol. 2002;116:532e5.
Corbett HJ, Mann KS, Mitra I, Jesudason EC, Losty PD, Clarke RW. Tracheostomyda 10-year experience from a UK pediatric surgical center. J Pediatr Surg. 2007; 42:1251e4.
Lawrason A, Kavanagh K. Pediatric tracheotomy: Are the indications changing? Int J Pediatr Otorhinolaryngol. 2013;77:922-5.
McPherson ML, Shekerdemian L, Goldsworthy M, Minard CG, Nelson CS, Stein F, et al. A decade of pediatric tracheostomies: Indications, outcomes, and long term prognosis. Pediatr Pulmonol. 2017;52:946 53.
Ozmen S, Ozmen OA, Unal OF. Pediatric tracheotomies: A 37 year experience in 282 children. Int J Pediatr Otorhinolaryngol. 2009;73:959 61.
Butnaru CS, Colreavy MP, Ayari S, Froehlich P. Tracheotomy in children: Evolution in indications. Int J Pediatr Otorhinolaryngol. 2006;70:115-9.
Ang AH, Chua DY, Pang KP, Tan HK. Pediatric tracheotomies in an Asian population: The Singapore experience. Otolaryngol Head Neck Surg. 2005;133:246-50.
Watters K, O’Neill M, Zhu H, Graham RJ, Hall M, Berry J. Two-year mortality, complications, and healthcare use in children with medicaid following tracheostomy. Laryngoscope. 2016;126(11):2611-7.
Garrubba M, Turner T, Grieveson C. Multidisciplinary care for tracheostomy patients: a systematic review. Crit Care. 2009;13(6):R177.
Cetto R, Arora A, Hettige R, Nel M, Benjamin L, Gomez CM, et al. Improving tracheostomy care: a prospective study of the multidis-ciplinary approach. Clin Otolaryngol. 2011;36(5):482-8.
Hettige R, Arora A, Ifeacho S, Narula A. Improving tracheostomy management through design, implementation and prospective audit of a care bundle: how we do it. Clin Otolaryngol. 2008;33(5):488-91.
Abode KA, Drake AF, Zdanski CJ, Retsch-Bogart GZ, Gee AB, Noah TL. A multidisciplinary children’s airway center: impact on the care of patients with tracheostomy. Pediatrics. 2016;137(2):e20150455.
