Pediatric tracheostomy: ten year experience in an Intensive Care Unit

Pediatric tracheostomy indications have changed over the last 30 years, from acute and transient procedures secondary to airway obstruction to programmed tracheostomies indicated due to the need for chronic use of mechanical ventilation (MV). Objective: To describe indications and morbidity associated with pediatric tracheostomies during a ten-year period. Patients and Methods: Descriptive study. Clinical records review of discharged patients (< 15 years old) tracheostomized during their hospital stay between 2005 and 2015. Demographic and clinical variables were evaluated before and after tracheostomy, stay in intensive care unit, age at the time of the tracheostomy, indication of tracheostomy, early complications (< 7 days), late complications (> 7 days), and mortality. Results: 59 children with tracheostomy were analyzed, 36 (59%) tracheostomies were performed in children under 6 months, and 39 (60%) in males. 23 (39%) had a confirmed or under study genopathy and 25 (42%) had congenital heart disease. The main indications for tracheostomy were 58% secondary to airway disease and 42% due to chronic use of MV. Within the airway disease group, subglottic stenosis, vocal cord paralysis, and tracheobronchomalacia were the principal reasons for indication, and in the group of chronic use of MV, the main causes were bronchopulmonary dysplasia and chronic lung disease. We did not find tracheostomy-related mortality. 89% of the patients were discharged with tracheostomy and 59% with chronic use of MV. The probability of being discharged with a tracheostomy was higher in younger patients while the chronic use of MV at discharge was higher in patients with a greater number of extubation failures before tracheostomy. Conclusion: Tracheostomy is a safe procedure in children, where the predominant causes of indication are airway disease and the need for chronic use of MV. Most children with tracheostomies are discharged with tracheostomy and chronic use of MV. Younger children, those with difficult weaning, confirmed or suspected genopathy, or special health needs are at greater risk of needing tracheostomy and chronic use of MV.