Pediatric Tracheostomy

Abstract

Tracheostomy is a surgical technique where an incision is made in the anterior part of the neck to gain access to the airway through an incision in the trachea’s anterior wall. Tracheostomy mainly consists of two steps: one is making a hole in the trachea, and the second is suturing the trachea to the skin by obliterating the dead space between skin and trachea. The term Tracheotomy is just making a hole in the trachea. It is a meaningful, life-saving procedure, but it carries significant morbidity and even mortality compared to adults. Pediatric tracheostomy was not a commonly performed procedure in the past. Still, because of the increased availability of pediatric intensive care units and acceptable multidisciplinary practices, many premature babies started to survive instead of having multiple comorbidities. Previously, it was done in pediatric patients mainly to relieve upper airway obstruction, mainly caused by infections like Diphtheria, poliomyelitis, epiglottitis, laryngotracheitis, etc, there are changing trends in its indication. Currently, pediatric tracheostomy is primarily done for prolonged mechanical ventilation though there are other indications for this procedure in pediatric patients. Before deciding on tracheostomy, many factors need to be addressed like the cause for doing it, its implications mainly on the patient’s family, how long the child needs the tracheostomy tube, etc. Usually, a paediatric tracheostomy is done after two weeks of prolonged intubation, whereas an adult needs to be done after around a week. The surgical procedure of pediatric tracheostomy is different from adult tracheostomy. It requires more skill and care to avoid untoward complications, which can be fatal for the patient. This procedure should be done under general anaesthesia with the patient intubated and done in the operation theatre with good light and cautery. Backup from an anaesthesia expert plays a vital role during the procedure. Preferably, horizontal skin incision with a vertical incision over the trachea’s anterior wall at the third and fourth ring. Application of stay suture is an essential step before making the incision which will help in accidental decannulation. Good postoperative care should include humidification, regular suctioning and skincare. There are various complications of this procedure: bleeding, tube displacement, accidental decannulation, injury to the pleura etc. The ultimate goal is decannulation which can be achieved by treating the underlying cause and regular follow-up with flexible endoscopy. Thorough counselling and education of family members and caretakers are mandatory, which carries essential challenges on treating physicians.