Tracheostomy in children: A 9-year experience in a tertiary hospital in Korea

Kyunghoon Kim; Jong-Seo Yoon

doi:10.4168/aard.2019.7.3.137

Journal List > Allergy Asthma Respir Dis > v.7(3) > 1130421

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Kim and Yoon: Tracheostomy in children: A 9-year experience in a tertiary hospital in Korea

Original Article

Allergy Asthma Respir Dis 2019;7(3):137-141.

Published online: 12 July 2019

DOI: https://doi.org/10.4168/aard.2019.7.3.137

Tracheostomy in children: A 9-year experience in a tertiary hospital in Korea

Kyunghoon Kim, Jong-Seo Yoon

^¹Department of Pediatrics, College of Medicine, The Catholic University of Korea, Seoul Korea

Correspondence to: Jong-Seo Yoon https://orcid.org/0000-0002-5782-6175 Department of Pediatrics, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, 222 Banpo-daero, Seocho-gu, Seoul 06591, Korea Tel: +82-2-2258-6190, Fax: +82-2-537-4544, E-mail: pedjsyoon@catholic.ac.kr

Received 28 November 2018 Revised 16 March 2019 Accepted 19 March 2019

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Purpose

Tracheostomy has been increasingly performed in children, along with the improvements in neonatal and pediatric intensive care. The objective of this study was to describe the indications, comorbidities, complications, and outcomes of tracheostomy in children in a tertiary hospital.

Methods

This was a retrospective study of children who required tracheostomy in a tertiary hospital in Korea between April 2009 and March 2018. The medical records of the patients were retrospectively reviewed and analyzed.

Results

A total of 41 children underwent tracheostomy. The median age of the patients was 11.9 months (interquartile range [IQR], 5.4–179.2 months), and 20 (48.8%) were boys. Tracheostomy was performed commonly in respiratory disease (12 [29.2%]) and neurologic disease (17 [41.5%]). The indications of tracheostomy differed according to patient age. There were trends toward longer length of intubation (median, 78.0 days; IQR, 36.0–185.0 days), longer hospitalization (213.3±154.5 days), higher decannulation rate (32.0%) and lower complications (12.0%) in patients who received tracheostomy as an infant/toddler.

Conclusion

Regarding pediatric tracheostomy in this study, there were bimodal age distribution and consequential clinical differences depending on patient age.

References

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Fig. 1.

There were bimodal age distribution depending on the age of tracheostomy.

Table 1.

Demographics of subjects (n=41)

Variable	Value
Male sex	20 (48.8)
Age at tracheostomy (mo)	11.9 (5.4–179.2)
Preterm birth	15 (36.6)
Length of intubation before tracheostomy (day)	26 (13–102)
Length of hospitalization (day)	90 (53–229)

Values are presented as number (%) or median (interquartile range).

Table 2.

Indications for tracheostomy

Indication	No. of patients (%)
Airway obstruction	6 (14.6)
Subglottic stenosis	1 (2.4)
Laryngomalacia	4 (9.8)
Others^*	1 (2.4)
Respiratory disease	12 (29.2)
Bronchopulmonary dysplasia	6 (14.6)
Chronic respiratory failure	6 (14.6)
Neurologic disease	17 (41.5)
Hypoxic ischemic enphalopathy	5 (12.2)
Intractable epilepsy	3 (7.3)
Traumatic brain injury	6 (14.6)
Others^†	3 (7.3)
Congenital muscular disease	3 (7.3)
Craniofacial anomaly	3 (7.3)

^* Others: tension pneumothorax.

^† Others: cerebral palsy, meningoencephalitis, brain tumor.

Table 3.

Comorbidities in the patients

Comorbidities	No. of patients (%)
Congenital heart disease	12 (33.3)
Bronchopulmonary dysplasia	6 (16.7)
Neurologic disease	6 (16.7)
Gastrointestinal disease	2 (5.5)
Genetic disorder	6 (16.7)
Cancer	3 (8.3)
Others^*	1 (2.8)

* Others: relapsing polychondritis.

Table 4.

Clinical characteristics of the patients

Variable	Infant/toddler (n=25)	Adolescent (n=16)	P-value
Male sex	13 (52.0)	7 (43.8)	0.85
Age at tracheostomy (mo)	6.5 (2.6–9.2)	184.5 (175.2–200.6)	0.00
Length of intubation (day)	78.0 (36.0–185.0)	13.5 (7.0–17.0)	0.00
Indications for tracheostomy
Respiratory disease	10 (40.0)	2 (12.5)
Neurologic disease	7 (28.0)	10 (62.5)
Airway obstruction	3 (12.0)	3 (18.8)
Craniofacial anomaly	2 (8.0)	1 (6.2)
Congenital muscular disease	3 (12.0)	0 (0.0)
Length of MV (day)	107.0 (67.0–232.0)	17.0 (4.5–25.0)	0.00
Length of hospitalization (day)	213.3±154.5	74.6±65.0	0.00
Successful decannulation	8 (32.0)	3 (18.8)	0.57
Complications	3 (12.0)	6 (37.5)	0.12

Values are presented as number (%), median (interquartile range), or mean±standard deviation.

MV, mechanical ventilation.

Table 5.

Patients with successful decannulation after tracheostomy

Patient No.	GA (wk) Tr	Age at racheostom (mo)	Indications of tracheostomy	Duration of intubation (day)	Duration of tracheostomy (day)
1	32	6.5	HIE	196	320
2	33	8.8	BPD	264	44
3	35	7.0	BPD	211	256
4	26	11.9	BPD	356	165
5	28	9.6	BPD	287	357
6	27	7.5	BPD	226	176
7	38	1.9	Velopharyngeal insufficiency	20	867
8	37	2.6	BPD	78	2,084
9	Full term	204.3	SAH	10	51
10	Full term	199.1	SAH	13	38
11	Full term	215.7	Airway problem	16	106

GA, gestational age; HIE, hypoxic ischemic encephalopathy; BPD, bronchopulmonary dysplasia; SAH, subarachnoid hemorrhage.

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