PERCUTANEOUS DILATIONAL TRACHEOSTOMY IN CHILDREN AND TEENAGERS

Percutaneous dilational tracheostomy (PDT) is a new technique that has been successfully performed in adult patients who required long-term mechanical ventilation, but it has not been used in children. The auth ors report their initial experience with PDT in 11 children and teenag ers. The procedure is as follows. Using Seldinger's technique, the tra chea is cannulated with a guide-wire. It is then progressively dilated , to an appropriately sized tract, with dilators from a commercially a vailable kit. Then, a tracheostomy tube can be inserted into the trach ea, loaded over a dilator. Eleven children, aged 10 to 20 years, under went PDT in an average of 20 minutes. In eight cases, PDT was performe d at the bedside. One intraoperative and one postoperative complicatio n developed in the same patient; both complications were easily recogn ized and treated. Tracheal stenosis has not developed in eight decannu lated patients at an average of 43 +/- 30 weeks after decannulation. P DT appears to be a safe, potentially cost-effective alternative to ope n tracheostomy in young patients. Copyright (C) 1994 by W.B. Saunders Company