Pediatric tracheotomies: Changing indications and outcomes

Objective/Hypothesis: To study the outcomes and complications associated wi th pediatric tracheotomy, as web as the changing trend in indications and o utcomes since 1970. Study Design: Retrospective chart review at a major ter tiary care children's hospital. Methods: On children who underwent tracheot omy at Children's Hospital of the King's Daughters (Norfolk, VA) between 19 88 and 1998, inpatient and outpatient records were reviewed. Of 218 tracheo tomies, sufficient data were available on 204. Indications for tracheotomy were placed into the following six groups: craniofacial abnormalities (13%) , upper airway obstruction (19%), prolonged intubation (26%), neurological impairment (27%), trauma (7%), and vocal fold paralysis (7%). Results: The average age at tracheotomy was 3.2 +/- 0.6 years. Although the prolonged in tubation group was significantly younger than all others, the neurological impairment and trauma groups were significantly older. Decannulation was ac complished in 41%. Time to decannulation was significantly higher in the ne urological impairment and prolonged intubation groups, but was significantl y shorter in the craniofacial group, Complications occurred in 44%. Overall mortality was 19%, with a 3.6% tracheotomy-related death rate. Comparison of our series to other published series of pediatric tracheotomies since 19 70 shows fewer being performed for airway infections and more for chronic d iseases, with a corresponding increase in duration of tracheotomy and decre ased decannulation rates. Conclusions: Tracheotomy is a procedure performed with relative frequency at tertiary care children's hospitals. While child ren receiving a tracheotomy have a high overall mortality, deaths are usual ly related to the underlying disease, not the tracheotomy itself.