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Paediatric Pulmonology and Allergology
2008 April, Vol. XI, No. 1 (3849-3855)
TRACHEOSTOMY IN CHILDREN
Ernst Eber
Kliniken Abteilung für Pulmonologie und Allergologie Universität Klinik für Kinder und Jugendheilkunde, Auenbruggerplatz 30, A-8036 Graz, Austria
While in the past a significant proportion of tracheostomies was performed for acute life-threatening (infectious) upper airway obstruction, today the number of emergency tracheostomies is extremely low due to the implementation of vaccination programmes and improvements in material engineering and anaesthetic techniques. Congenital upper airway anomalies, resulting in a difficult airway that cannot be secured by other means, may necessitate transient or permanent tracheostomy. Many recommendations on the standards of care for children with a chronic tracheostomy are still by consensus, based on experience rather than scientific data. The indication for a tracheostomy (i.e. the underlying problem), the presence of other medical conditions, the patient’s anatomy, respiratory mechanics, and his/her needs for speech, ventilation and airway clearance all determine many aspects of care, the duration of cannulation, the occurrence of complications, and the probability of successful decannulation in a given patient. Based on experience and established practice it is recommended that children with chronic tracheostomies should undergo routine endoscopic evaluation, most preferably by flexible bronchoscopy, on a 6- to 12-month basis to assess the underlying airway pathology and thus determine the readiness for decannulation, to detect (and treat) complications such as granuloma formation, tracheal stenosis or tracheomalacia, and suprastomal collapse at an early stage. A large proportion of these complications, however, is preventable or may at least be minimised by good tracheostomy care and clinical evaluation of the patients at regular intervals, tailored to the needs of the individual child. Thus the care of the child with a chronic tracheostomy has to be tailored to the needs of the individual patient, and this is only possible in a specialized tertiary care unit where all the necessary diagnostic techniques and highly experienced staff are available.