PEDIATRIC TRACHEOSTOMY - LONG-TERM EVALUATION

Considerable debate exists in the literature concerning the immediate and long-term risks of tracheostomy in the pediatric age group. Much has been written of the hazards of decannulation in these patients. A review of the experience of tracheostomy in patients under 18 yr of age at the Shands Teaching Hospital was undertaken. One hundred and eight children underwent tracheostomy between January, 1967, and August, 1976. There were 74 males and 34 females. Twenty-eight patients (27%) were less than 30 days of age at the time of tracheostomy and 68 (63%) were less than 1 yr of age. The indications for tracheostomy were varied, but 73 were performed because of mechanical airway obstruction or respiratory insufficiency. The vast majority (106) were performed on an elective basis and most of the cannulas employed were either silastic or polyvinyl chloride (88). Complications of tracheostomy were minor with 11 instances of pneumomediastinum or pneumothorax. Two patients have developed secondary tracheal stenosis that may have been caused by the tracheostomy. The overall mortality was 44% with 7 patients succumbing from complications of the tracheostomy itself. Four of these were in homemanaged patients. Forty-four of 49 patients considered candidates for decannulation have been successfully extubated. Tracheostomy in the pediatric age group appears to be well-tolerated as long as meticulous care is taken in the performance of the procedure and in follow-up. Decannulation has not been a significant problem in our series. © 1979 Grune & Stratton, Inc.