Pediatric Tracheostomy

Excerpt

Tracheostomy is one of the oldest known surgical procedures. In 1718, Lorenz Heister coined the term "tracheostomy" to describe creating an opening in the neck and inserting a tube into the trachea. Medical and surgical advances have significantly improved this airway management procedure. Otolaryngologists and pediatric surgeons can perform tracheostomies on pediatric patients, and healthcare teams provide essential support for long-term stoma care, family education, supplies, and potentially mechanical ventilation. While perioperative and long-term care responsibilities may differ between hospitals, consensus guidelines have been established to ensure a standardized approach to caring for these patients across various disciplines. This activity reviews the general knowledge, operative considerations, wound care recommendations, and long-term strategies for pediatric tracheostomies by drawing on current literature. It will also address controversies and discussions surrounding decannulation protocols and highlight the role of the interprofessional team in caring for patients who undergo this procedure.

The modern tracheostomy can be traced back to Armand Trousseau, who used the procedure to treat diphtheria-induced breathing difficulties in the mid-1800s. Chevalier Jackson later standardized the tracheostomy process in the early 1900s. While tracheostomy is deemed a life-saving procedure, older evidence indicates it poses a greater risk to children than adults. However, recent decades have witnessed a significant shift in indications for tracheostomy in pediatric patients due to improved survival rates among premature infants and those born with severe congenital anomalies.

In the past, tracheostomy was typically employed for upper airway obstructions caused by infectious diseases, such as diphtheria. However, most pediatric tracheostomies performed in current clinical practice are indicated to support prolonged ventilation or address such problems as laryngotracheal stenosis, neurological disorders, trauma, or airway obstruction due to craniofacial abnormalities. While some medical professionals might still view pediatric tracheostomy as risky, new research indicates that its inherent risk may not be as significant as previously thought.