Neurologic Comorbidities, Failure to Thrive Negatively Affect Pediatric Decannulation

by Amy E. Hamaker •

What are the epidemiology, outcomes, and factors associated with successful decannulation in children undergoing tracheostomy?

Bottom line: Younger age at tracheostomy and longer cannulation period were associated with higher late postoperative complication rates. Neurologic comorbidities and FTT were risk factors for unsuccessful decannulation after pediatric tracheostomy.

Background: Tracheostomy placement is associated with significant morbidity and mortality. Prolonged tracheostomy predisposes to medical complications, such as airway infections and mucous plugging, and limits language and social development. Data are limited in risk factor description for long-term outcomes of critically ill children undergoing tracheostomy, especially from Asia.

Study design: Retrospective case series analysis on 105 pediatric tracheostomies performed from 2006 to 2016.

Setting: KK Women’s and Children’s Hospital, Singapore.

Synopsis: Eighty-one children had a preexisting comorbidity (the most common was prematurity), and 44 had preexisting failure to thrive (FTT). The most common indication was anatomic airway obstruction. There were 37 neurologic tracheostomy indications, and cardiorespiratory causes due to pulmonary insufficiency or cardiac malformations were an indication in 32 cases. Ninety-one patients required invasive mechanical ventilation (MV) prior to tracheostomy. One perioperative complication, six early complications, and 67 late complications occurred. (The most common were pneumothorax and suprastomal granulation requiring intervention). Patients with postoperative complications were younger, had a lower body weight, had cancer, and had a longer time to decannulation. In-hospital mortality was 14 of 105; deaths were a result of their primary disease. At discharge, out of 91 patients, 12 required supplemental oxygen and 40 required MV. Out of 105 patients, 41 underwent successful decannulation. Unsuccessful decannulation was more common in patients with FTT and neurologic comorbidities. Limitations included the study’s retrospective and single-center design, classification differences for tracheostomy indications, and a lack of data to determine the direct source of postoperative complications.

Citation: Chia AZH, Ng ZM, Pang YX, et al. Epidemiology of pediatric tracheostomy and risk factors for poor outcomes: an 11-year single-center experience. Otolaryngol Head Neck Surg. 2020;162:121-128.