TRACHEOTOMY IN PEDIATRIC PATIENTS

Pediatric tracheotomy differs from tracheotomy in adults, not only in indications but also in operative techniques, postoperative complications and postoperative care. Indications for tracheotomy,v have changed during history. Whereas upper airway infections such as diphtheria and croup were the main reasons for tracheotomy in the past, the indications have been modified upon the discovery of antibiotics. Currently, tracheotomy is mostly used for upper airway obstruction clue to congenital malformations, or to facilitate assisted ventilation and lower airway toilet. Pediatric tracheotomy is more, difficult because of anatomic variation between children and adults, emergency tracheotomy in particular, which is fortunately rarely required. Although endotracheal intubation is currently a procedure of great relevance that in some cases precedes tracheotomy, prolonged intubation leads to severe airway lesions, thus appropriate timing of tracheotomy is of utmost importance. Operative techniques have not Yet been standardized and various methods are employed (e.g., tracheal and dermal access), with variable results. The term childhood refers to a wide age span from neonatal age through 18 Years of age; therefore the approach in tracheotomy varies according to the child's age. The most severe postoperative complications include tracheal stenosis and suprastomal collapse of the anterior tracheal wall. postoperative difficulties in swallowing, speech and decannulation are more pronounced in children, making the postoperative cow-se and recovery more complex. Parental preparation for a tracheotomized child and proper education of medical personnel and parents in due care of such a child are crucial for favorable outcome.