Pediatric tracheostomy: A 10-year experience in 121 Thai children

Abstract

Objectives

To describe the epidemiology, indications, complications, mortality and outcomes in pediatric tracheostomy over 10 years at Ramathibodi Hospital, Mahidol University, Bangkok, Thailand while identifying factors associated with unsuccessful decannulation.

Subjects and methods

A single-center case series was conducted on pediatric tracheostomies performed from January 2013 to June 2023.

Results

121 tracheostomies were performed in Thai children at Ramathibodi Hospital. The median age at tracheostomy was 1.4 [IQR 0.3, 5.3] years. The two most common indications were upper airway obstruction (52 %) and prolonged intubation (34 %). Six patients (5.0 %) developed intraoperative complications, including cardiac arrest (1.7 %), hypoxia (1.7 %), esophageal injury (0.8 %), and death (0.8 %). The early postoperative complication was one case of pneumothorax (0.8 %). Late complications (68 %) included peristomal granuloma (28 %) and tracheitis (9 %), bleeding (8.2 %), distal tracheal granuloma (8.2 %), accidental decannulation (8.2 %), and local wound infection (6.4 %). The tracheostomy-related mortality rate was 3.6 % from tube occlusion due to secretion block (0.9 %), trachea-innominate artery fistula (0.9 %), accidental disconnection from a mechanical ventilator (0.9 %), and distal tracheal granuloma obstructing the trachea (0.9 %). The decannulation success rate was 21 %. Unsuccessful decannulation was associated with patients under 2 years old at the time of tracheostomy, as well as comorbidities such as gastroesophageal reflux disease and neurological disorder. These findings remained significant on multivariate analysis (adjusted hazard ratio 0.36 [95 % CI, 0.15, 0.90], P = 0.029 for age younger than 2 years, 0.27 [95 % CI, 0.10, 0.78], P = 0.015 for GERD and 0.15 [95 % CI, 0.05, 0.46], P = 0.001 for neurological comorbidities, respectively.

Conclusion

Patients in younger age groups or those with gastroesophageal reflux disease and neurological comorbidities were more difficult to decannulate. Further studies should focus on investigating the potential benefits of managing reflux symptoms in improving the decannulation rates for patients.