Abstract
Objectives
We chose to review the outcomes of tracheotomies performed at San Jorge Children's Hospital, San Juan, Puerto Rico, over the last 15 years. Our objectives were: 1) Understand changing trends in the indications for tracheotomy and a perceived reduction in decanulation rates. 2) Be able to propose recommendations for the coordinated care of children with tracheotomy.
Methods
A retrospective chart review was performed of 189 patients undergoing tracheotomy from January 1991 to December 2006. The data were tabulated for age, diagnosis, complications, and outcome. Patients were divided in groups based on the indication for tracheotomy.
Results
5 groups were identified based on the indication for tracheotomy: 1) True vocal cord paralysis: 11% of the study population with a 25% decanulation rate. 2) Airway obstruction: 21% of the study population with a 90% decanulation rate. 3) Craniofacial malformation: 8% of the study population with a 0% decanulation rate. 4) Neurological impairment: 46% of the study population with a 0% decanulation rate. 5) Prolonged intubation: 14% of the study population with a 25% decanulation rate. We report no intraoperative complications, an 18% overall complication rate, and a 10% mortality.
Conclusions
Over the last decades, the indications for tracheotomy have shifted toward children with underlying neurological impairment and need for prolonged mechanical ventilation. Decanulation rates for these children are significantly lower (approximately 10%) than for children with obstructive airway pathology (90%). Therefore, the care of these children and their tracheotomies will require coordinated multidisciplinary settings. We present several recommendations to achieve this goal.
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