Tracheostomy in infants: indications and outcomes

Abstract

Background/Aim. Prolonged ventilation is the most common indication for pediatric tracheostomy. The aim of the study was to determine the indications, possible com-plications, and outcomes of tracheostomy in infants, as well as the association of patient phenotype with compli-cations following tracheostomy. Methods. This retrospec-tive study highlights the main indications, complications, and decannulation rates in tracheostomy pediatric patients treated at the Institute of Mother and Child Health Care of Serbia "Dr. Vukan Čupić", Belgrade, for three years. Results. A total of 38 infants were included in our retro-spective study, 31 (81%) of whom underwent elective tra-cheostomy, and 7 (19%) underwent urgent tracheostomy due to acute respiratory distress and difficult intubation. The mean age was 5.4 ± 3.5 months, and the youngest participant was 36 hrs old. The primary indication for elec-tive tracheostomy was prolonged mechanical ventilation in 13 (42%) patients, neuromuscular disorders in 5 (16%), airway obstruction in 10 (32%), craniofacial anomalies in 2 (5%), and pulmonary disease in 1 (3%) patient. Early complications (occurring within the first seven days after tracheostomy) were present in 4 (10.5%) patients, three of whom had air leaks (due to inappropriate cannula selec-tion), whereas wound dehiscence was reported in one pa-tient. Late complications (those occurring more than seven days after tracheostomy) were reported in 4 (10.5%) pa-tients and they were peristomal granulations in three pa-tients and tube obstruction in one patient. There were no deaths associated with tracheostomy, although overall mortality was 21% (8 patents). All of these patients died as a result of their primary diseases. Seventeen (44%) patients were successfully decannulated. Conclusion. Most pa-tients required long-term treatment and tracheostomy re-tention due to the nature of their primary diseases, which coincided with low decannulation rates. Therefore, trache-ostomies should preferentially be carried out in specialized pediatric centers with trained medical personnel ensuring adequate health care. © 2024 Inst. Sci. inf., Univ. Defence in Belgrade. All rights reserved.