Tracheotomy decannulation in children under one year of age
Luis Cardoso, João Carlos Ribeiro, João Neves, Mário Cruz, Luís Silva
Abstract
Introduction: Pediatric tracheotomy indications and outcomes have changed over the last decades. More tracheotomies have been performed in the first year of life than in any other pediatric age group. Information on decannulation for this group is scarce in the literature. Objective: To characterize indications, outcomes, and decannulation rates in children under one year of age who have been tracheotomized at a Portuguese tertiary hospital over a 15-year period. Materials and Methods: Data was obtained from 16 newborns and infants and analyzed with respect to age, gender, primary diagnosis, indication for tracheotomy, complications, mortality, and time to decannulation. Results: Tracheotomy was required following prolonged positive pressure ventilation in 62.5% of patients and for upper airway obstruction in 37.5%. Congenital disorders were diagnosed in 87.5% of patients. Tracheotomy complications were observed in 56.3% of patients with accidental decannulation rate of 25%. The observed mortality rate was 44% at the median age of 13.7 months. Decannulation was performed successfully after tracheotomy in 25% of surviving patients (mean age of 25.5 months). Congenital anomalies were present in almost all cases and were correlated with higher complication and mortality rates, which reflects and precludes decannulation in those patients. Conclusion: Tracheotomy decannulation after clinical evaluation and serial airway endoscopies in children tracheotomized before one year old is a very safe, controllable procedure. It is more feasible in upper airways disorders, with a 50% successful decannulation rate, two years post-operatively.
Keywords
References
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