Indications, risk of lower airway infection, and complications to pediatric tracheotomy: report from a tertiary referral center

Abstract

Background: Although pediatric tracheotomy is potentially life-saving, the procedure is associated with high risk of complications, and indications have changed the last decade. We report indications, complications, and lower airway infections (LAIs) to pediatric tracheotomy performed at a tertiary referral center.

Methods: We identified all children (<18 years) who underwent tracheotomy at our institution during 2008–2015. A review of hospital records was performed to extract data on indication of the procedure, complications, and information on pre- and postoperative LAI.

Results: At a median age of 8 years (range: 4 months to 17 years), a total of 69 tracheotomies were performed. Neuromuscular disease (n = 21) was the most common cause for tracheotomy. The postoperative complication rate was 22%; early complications (<30 days) occurred in four patients, and nine patients encountered late complications such as wound granulation and tracheocutaneous fistula. Children without LAI prior to tracheotomy were at increased risk of LAI from the initial 30-days following surgery (OR: 2.91, 95% CI: 1.17–7.21; p = .02). Fifty-three percent (10/19) of all LAIs following tracheotomy were caused by Staphylococcus aureus (p < .01).

Conclusions: Pediatric tracheotomy was associated with considerable rates of minor early and late complications and high risk of short-term LAI. The main cause leading to tracheotomy was neuromuscular disease.

Chinese abstract

背景：虽然儿科气管切开术是潜在的生命拯救手术, 它与高风险并发症相关, 并且在过去十年指征改变了。我们报告在三级转诊中心进行的儿童气管切开术的指征、并发症和下呼吸道感染（LAI）。

方法：我们指认出在2008-2015年期间在我院接受气管切开术的所有儿童（<18岁）。对医院记录进行审查, 提取关于手术指征、并发症以及术前和术后LAI信息的数据。

结果：中位年龄为8岁（年龄范围：4个月至17岁）；共进行69次气管切开术。神经肌肉疾病（n = 21）是气管切开术的最常见病因。术后并发症发生率为22％；四个患者得早期并发症（<30天）, 9名患者得晚期并发症, 如伤口造粒和气管皮肤瘘。气管切开术前没有LAI的儿童在手术后最初30天内的LAI风险增加（OR：2.91,95％CI：1.17-7.21; p = 0.02）。气管切开术后百分之五十的LAI（10/19）是由金黄色葡萄球菌引起的（p <0.01）。

结论：儿童气管切开术与相当大比例的早期和晚期轻微并发症和短期LAI高风险相关。气管切开术的主要病因是神经肌肉疾病。

Keywords:

• Tracheotomy
• Tracheotomy
• pediatric

Disclosure statement

The authors declare no conflicts of interest.

Additional information

Funding

CG is funded by the Candys Foundation and Kræftfonden (The Cancer Foundation).