TRACHEOSTOMY IN INFANTS WITH CHRONIC RESP IRATORY-FAILURE

From 1981 through 1991, tracheostomy was used in 26 infants with bronc hopulmonary dysplasia and 5 infants with idiopathic pulmonary fibrosis . All 31 patients (group I) were treated in an intensive care unit. A cuffless tube was used in 22 patients (group Ia), whereas nine patient s (group Ib) received mechanical ventilation under sedation through a tube with a cuff. The control group (group II) included 30 tracheostom ies performed with cuffless tubes in 25 infants with ENT conditions an d 5 infants with neurological disease. Rate of early complications (< 8 days) was higher in group la (63.7 %) (loss of the tube in nine case s, bronchospasm in one, pneumothorax in two, and fatal septicemia in t wo) than in group II (23.3 %, p < 0.01). No early complications occurr ed in group Ib. Rate of delayed complications was similar in groups Ia + Ib and II. These data show that : (1) tracheostomy involves greater risk in infants with chronic respiratory failure than in infants with normal lungs ; (2) controlled mechanical ventilation through a cuffed tube is effective in preventing posttracheostomy complications ; (3) the latter technique improves the safety of tracheostomy, which is ess ential to normal psychological and neurological development.