Complications of tracheostomy in children: a systematic review

Lubianca Neto, José Faibes; Castagno, Octavia Carvalhal; Schuster, Artur Koerig

doi:10.1016/j.bjorl.2020.12.006

Acessibilidade / Reportar erro

Brasil

Brazilian Journal of Otorhinolaryngology

Español English

Brasil

Español English

sumário « anterior atual seguinte »

Sumário

Original article • Braz. j. otorhinolaryngol. 88 (6) • Nov-Dec 2022 • https://doi.org/10.1016/j.bjorl.2020.12.006 copy

Complications of tracheostomy in children: a systematic review

Authorship SCIMAGO INSTITUTIONS RANKINGS

Abstract

Introduction:

Tracheostomy is a procedure that can be associated with several well-described complications in the literature, which can be divided into transoperative, early postoperative and late postoperative. When performed in children, these risks are more common than in adults.

Objective:

To perform a systematic review of complications, including deaths, in tracheostomized pediatric patients.

Methods:

A search was carried out for articles in the Latin American and Caribbean Health Sciences Literature and PubMed databases. Cohort studies and series reports were selected, in addition to systematic reviews, published between January 1978 and June 2020, with patients up to 18 years old, and written in English, Spanish or Portuguese.

Results:

1560 articles were found, of which 49 were included in this review. The average complication rate was 40%, which showed an association with age, birth weight, prematurity, comorbidities, and emergency procedures. The most common complications were cutaneous lesions and granulomas. Mortality related to the procedure reached up to 6% in children and was mainly related to cannula obstruction or accidental decannulation.

Conclusion:

Pediatric tracheostomy is associated with several complications. The tracheostomy-related mortality rate is low, but the overall mortality of tracheostomized patients is not negligible.

Keywords
Tracheostomy; Child; Complication; Mortality

Author	Year of publication	n	Tracheostomy-related mortality (%)	Overall mortality (%)
Baker and Chorney³⁰30 Baker LR, Chorney SR. Reducing pediatric tracheostomy wound complications: an evidence-based literature review. Adv Skin Wound Care. 2020;33:324–8.	2020	1607	–	–
Lee et al.⁴⁷47 Lee DJ, Yang W, Propst EJ, Rosenblatt SD, Hseu A, Wolter NE. Tracheo-innominate fistula in children: a systematic review of literature. Laryngoscope. 2020;130:217–24.	2019	77	30 (38.9%)	30 (38.9%)
Syed et al.¹⁸18 Syed KA, Naina P, Pokharel A, John M, Varghese AM. Paediatric tracheostomy: a modified technique and its outcomes, results from a South Indian tertiary care. Int J Pediatr Otorhinolaryngol. 2019;118:6–10.	2019	50	0	9 (18%)
Maunsell et al.²⁹29 Maunsell R, Avelino M, Caixeta Alves J, Semenzati G, Lubianca Neto JF, Krumenauer R, et al. Revealing the needs of children with tracheostomies. Eur Ann Otorhinolaryngol Head Neck Dis. 2018;135:93–7.	2018	160	2 (1.3%)	29 (18.1%)
Feehs et al.⁴¹41 Feehs KR, Maslan JT, Kirse DJ. Superiorly-based turnover skin flap: Pediatric tracheocutaneous fistula closure. Int J Pediatr Otorhinolaryngol. 2018;107:21–4.	2018	57	–	–
Shay et al.²⁴24 Shay S, Shapiro NL, Bhattacharyya N. Revisits after pediatric tracheotomy: airway concerns result in returns. Int J Pediatr Otorhinolaryngol. 2018;104:5–9.	2018	2248	–	118 (5.2%)
Schweiger et al.¹⁷17 Schweiger C, Manica D, Becker CF, Abreu LSP, Manzini M, Sekine L, et al. Tracheostomy in children: a ten-year experience from a tertiary center in southern Brazil. Braz J Otorhinolaryngol. 2017;83:627–32.	2017	123	–	38 (31%)
Dal’Astra et al.¹1 Dal’Astra APL, Quirino AV, Caixeta JAS, Avelino MAG. Tracheostomy in childhood: review of the literature on complications and mortality over the last three decades. Braz J Otorhinolaryngol. 2017;83:207–14.	2017	5933	60 (1%)	734 (12.4%)
Ha et al.⁴⁰40 Ha TA, Goyal M, Ongkasuwan J. Duration of tracheostomy dependence and development of tracheocutaneous fistula in children. Laryngoscope. 2017;127:2709–12.	2017	164	–	–
Schwarz et al.⁴⁴44 Schwarz Y, Muhanna N, Raveh D, Shaul C, Shahroor S, Peleg U, et al. Starplasty tracheostomy: case series and literature review. Eur Arch Otorhinolaryngol. 2017;274:2261–6.	2017	39	0	4 (10.3%)
Mahida et al.⁶6 Mahida JB, Asti L, Boss EF, Shah RK, Deans KJ, Minneci PC, et al. Tracheostomy placement in children younger than 2-years: 30-day outcomes using the national surgical quality improvement program pediatric. JAMA Otolaryngol Head Neck Surg. 2016;142:241–6.	2016	206	12 (5.8%)	12 (5.8%)
Watters et al.¹²12 Watters K, O’Neill M, Zhu H, Graham RJ, Hall Matthew, Berry J. Two-year mortality, complications, and healthcare use in children with medicaid following tracheostomy. Laryngoscope. 2016;126:2611–7.	2016	502	–	45 (9%)
Garcia-Urabayen et al.²⁷27 Garcia-Urabayen D, López-Fernandez YM, Pilar-Orive J, Nieto-Faza M, Gil-Antón J, López-Bayón J, et al. Analysis of tracheostomies in a pediatric intensive care unit during the period 2003-2013. An Pediatr (Barc). 2016;84:18–23.	2016	25	1 (4%)	5 (20%)
McCaleb et al.³⁵35 McCaleb R, Warren RH, Willis D, Maples HD, Bai S, O’Brein CE. Description of respiratory microbiology of children with long-term tracheostomies. Respir Care. 2016;61:447–52.	2016	93	–	–
Levi et al.⁴⁶46 Levi JR, Topf MC, Mostovich NK, Yoo E, Barth PC, Shah UK. Stomal maturation does not increase the rate of tracheocutaneous fistulas. Laryngoscope. 2016;126:2395–8.	2016	264	0	58 (22%)
Douglas et al.²⁵25 Douglas CM, Poole-Cowley J, Morrissey S, Kubba H, Clement WA, Wynne D. Pediatric tracheostomy – an 11-year experience at a Scottish paediatric tertiary referral centre. Int J Pediatr Otorhinolaryngol. 2015;79:1673–6.	2015	95	0	21 (19.9%)
Song et al.²⁶26 Song JJ, Choi IJ, Chang H, Kim DW, Chang HW, Park GH, et al. Pediatric tracheostomy revisited: a nine-year experience using horizontal intercartilaginous incision. Laryngoscope. 2015;125:485–92.	2015	111	2 (1.8%)	17 (15.3%)
Van Buren et al.²⁸28 Van Buren NC, Narasimham ER, Curtis JL, Muntz HR, Meier JD. Pediatric tracheostomy: timing of the first tube change. Ann Otol Rhinol Laryngol. 2015;124:374–7.	2015	151	5 (3.3%)	19 (12.6%)
Olgivie et al.³¹31 Olgivie LN, Kozak JK, Chiu S, Adderley RJ, Kozak FK. Changes in pediatric tracheostomy 1982-2011: a Canadian tertiary children’s hospital review. J Pediatr Surg. 2014;49:1549–53.	2014	248	5 (2%)	37 (15%)
Afolabi-Brown et al.³⁸38 Afolabi-Brown O, Marcus M, Speciale P, Pagala M, Kazachkov M. Bronchoscopic and nonbronchoscopic methods of airway culturing in tracheostomized children. Respir Care. 2014;59:582–7.	2014	20	–	–
Provenzano et al.⁴⁸48 Provenzano MJ, Rutter MJ, Von Allmen D, Manning PB, Boesch PR, Putnam PE, et al. Slide tracheoplasty for the treatment of tracheoesophageal fistulas. J Pediatr Surg. 2014;49:910–4.	2014	9	–	–
Trey et al.¹⁴14 Trey L, Niedermann E, Ghelfi D, Gerber A, Gysin C. Pediatric tracheotomy: a 30-year experience. J Pediatr Surg. 2013;48:1470–5.	2013	119	1 (0.8%)	25 (23%)
Cline et al.³⁷37 Cline JM, Woods CR, Ervin SE, Rubin BK, Kirse DJ. Surveillance tracheal aspirate cultures do not reliably predict bacteria cultured at the time of an acute respiratory infection in children with tracheostomy tubes. Chest. 2012;141:625–31.	2012	170	–	–
Pérez-Ruiz et al.³3 Pérez-Ruiz E, Caro P, Pérez-Fnás J, Cols M, Barrio I, Torrent A, et al. Paediatric patients with a tracheostomy: a multicentre epidemiological study. Eur Respir J. 2012;40:1502–7.	2012	249	8 (3.2%)	31 (12.5%)
Nobre et al.²¹21 Nobre S, Roda J, Félix M, Estêvão MH. Traqueostomia em idade pediátrica – experiência de um quarto de século. Acta Pediatr Port. 2011;42:269–75.	2011	27	0	4 (14.8%)
Genther and Thorne	2010	421	–	–
Itamoto et al.³²32 Itamoto CH, Lima BT, Sato J, Fujita RR. Indicações e complicações de traqueostomia em crianças. Braz J Otorhinolaryngol. 2010;76:326–31.	2010	58	2 (3.4%)	–
Al-Samri et al.³³33 Al-Samri M, Mitchell I, Drummond DS, Bjornson C. Tracheostomy in children: a population-based experience over 17 years. Pediatr Pulmonol. 2010;45:487–93.	2010	72	1 (1.4%)	11 (15.3%)
Colman et al.³⁶36 Colman KL, Mandell DL, Simons JP. Impact of stoa maturation on pediatric tracheostomy-related complications. Arch Otolaryngol Head Neck Surg. 2010;136:471–4.	2010	172	–	–
Tasca and Clarke⁴²42 Tasca RA, Clarke RW. Tracheocutaneous fistula following paediatric tracheostomy – a 14-year experience at Alder Hey Children’s. Int J Pediatr Otorhinolaryngol. 2010;74:711–2.	2010	193	–	–
Özmen et al.²⁰20 Özmen S, Özmen AO, Ünal OF. Pediatric tracheostomies: a 37-year experience in 282 children. Int J Pediatr Otorhinolaryngol. 2009;73:959–61.	2009	282	3 (1%)	34 (19%)
Pereira et al.¹⁹19 Pereira KD, McGregor AR, Mitchell RB. Complications of neonatal tracheostomy: a 5-year review. Otolaryngol Head Neck Surg. 2004;131:810–3.	2004	55	0	9 (16%)
Solares et al.⁴³43 Solares CA, Krakovitz P, Hirose K, Koltai PJ. Starplasty: revisiting a pediatric tracheostomy technique. Otolaryngol Head Neck Surg. 2004;131:717–22.	2004	94	0	8 (8.5%)
Kremer et al.⁹9 Kremer B, Botos-Kremer AI, Schlondorff G. Indications, complications, and surgical techniques for pediatric tracheostomies -– an update. J Pediatr Surg. 2002;37:1556–62.	2002	25	0	5 (20%)
Greenberg et al.¹⁰10 Greenberg JS, Sulek M, de Jong A, Friedman EM. The role of postoperative chest radiography in pediatric tracheostomy. Int J Pediatr Otorhinolaryngol. 2001;60:41–7.	2001	200	–	–
Carr et al.¹⁵15 Carr MM, Pje CP, Kingston L, Kielma D, Heard C. Complication in pediatric tracheostomies. Laryngoscope. 2001;111:1925–8.	2001	142	1 (0.7%)	21 (15%)
Nakanishi et al.³⁹39 Nakanishi M, Montovani JC, Nakajima V, Macharelli CA. Traqueotomia na infância. Braz J Otorhinolaryngol. 2001;67:153–8.	2001	73	1 (1.4%)	–
Carron et al.²¹21 Nobre S, Roda J, Félix M, Estêvão MH. Traqueostomia em idade pediátrica – experiência de um quarto de século. Acta Pediatr Port. 2011;42:269–75.	2000	204	7 (3.6%)	39 (19%)
Park et al.⁴⁵45 Park JY, Suskind DL, Prater D, Muntz HR, Lusk RP. Maturation on the pediatric tracheostomy stoma: effect on complications. Ann Otol Rhinol Laryngol. 1999;108:1115–9.	1999	149	0	–
Coln et al.⁴4 Coln CE, Purdue GF, Hunt J. Tracheostomy in the young pediatric burn patient. Arch Surg. 1998;133:537–9.	1998	76	–	–
Ward et al.⁵⁰50 Ward RF, Jones J, Carew JF. Current trends in pediatric tracheotomy. Int J Pediatr Otorhinolaryngol. 1995;32:233–9.	1995	103	3 (2.9%)	37 (36%)
Citta-Pietrolungo et al.⁵5 Citta-Pietrolungo TJ, Alexander MA, Cook SP, Padman R. Complications of tracheostomy and decannulation in pediatrics and young patients. Arch Phys Med Rehabil. 1993;74:905–9.	1993	30	–	–
Schlessel et al.¹¹11 Schlessel JS, Harper RG, Rappa H, Kenigsberg K, Khanna S. Tracheostomy: acute and long-term mortality and morbidity in very low birth weight premature infants. J Pediatr Surg. 1993;28:873–6.	1993	36	4 (11%)	13 (36.1%)
Rosenfeld and Stool⁴⁹49 Rosenfeld RM, Stool SE. Should granulomas be excised in children with long-term tracheotomy? Arch Otolaryngol Head Neck Surg. 1992;118:1323–7.	1992	50	–	–
Gianoli et al.⁸8 Gianoli GJ, Miller RH, Guarisco JL. Tracheotomy in the first year of life. Ann Otol Rhinol Laryngol. 1990;99:896–901.	1990	60	1 (1.7%)	25 (42%)
Kenna et al.⁷7 Kenna M, Reilly JS, Stool SE. Tracheostomy in preterm infant. Ann Otol Rhinol Laryngol. 1987;96:68–71.	1987	124	3 (2.4%)	31 (25%)
Newlands and McKerrow²³23 Newlands WJ, McKerrow WS. Paediatric tracheostomy. Fifty-seven operations on fifty-three children. J Laryngol Otol. 1987;101:929–35.	1987	53	0	9 (17%)
Gaudet et al.¹³13 Gaudet PT, Peersless A, Sasaki CT, Kirchner JA. Pediatric tracheostomy and associated complications. Laryngoscope. 1978;88:1633–41.	1978	123	4 (3%)	18 (14.6%)
Perrotta and Schley	1978	61	3 (4.9%)	–

Complication	Total reported (%)
Skin lesions	1245 (23.7)
Granuloma	1073 (20.4)
Tracheocutaneous fistula	497 (9.5)
Accidental decannulation	438 (8.3)
Cannula obstruction	419 (8)
Skin infection	385 (7.3)
Pneumothorax	222 (4.2)
Pneumomediastinum	179 (3.4)
Tracheitis	148 (2.8)
Tracheal stenosis	138 (2.6)
Bleeding	94 (1.8)
Tracheo-innominate fistula	78 (1.5)
Pneumonia	61 (1.2)
Subglottic stenosis	58 (1.1)
Suprastomal collapse	51 (1)
Tracheomalacia	37 (0.7)
Subcutaneous emphysema	28 (0.5)
Air leak with impact on ventilation	23 (0.4)
Sepsis	15 (0.3)
Tracheal erosion	15 (0.3)
Glottic stenosis	13 (0.3)
False passage	10 (0.2)
Aspiration	7 (0.1)
Tracheoesophageal fistula	6 (0.1)
Suture dehiscence	3 (0.06)
Tracheal rupture	2 (0.04)
Stomal keloid	2 (0.04)
Stomal stenosis	1 (0.02)
Tracheal necrosis	1 (0.02)
Cricothyroid intubation	1 (0.02)

Transoperative

Hemorrhage, subcutaneous emphysema, pneumomediastinum, pneumothorax, cricoid incision, esophageal puncture, recurrent laryngeal nerve injury, incorrect cannula choice, selective intubation, cardiorespiratory arrest, death.

Postoperative

Early

Tracheostoma bleeding, accidental decannulation, cannula obstruction, local infection (cellulitis), peri-cannula air leak (difficulty in mechanical ventilation).

Late

Accidental decannulation, cannula obstruction, local and bronchial infection, suprastomal collapse, tracheal stenosis, tracheocutaneous fistula, tracheoesophageal fistula, tracheo-vascular fistula with innominate artery, subglottic stenosis, tracheal granuloma (distal and suprastomal), death.

Associação Brasileira de Otorrinolaringologia e Cirurgia Cérvico-Facial. Sede da Associação Brasileira de Otorrinolaringologia e Cirurgia Cérvico Facial, Av. Indianópolia, 1287, 04063-002 São Paulo/SP Brasil, Tel.: (0xx11) 5053-7500, Fax: (0xx11) 5053-7512 - São Paulo - SP - Brazil
E-mail: revista@aborlccf.org.br

Acompanhe os números deste periódico no seu leitor de RSS

[1] * Corresponding author at: Universidade Federal de Ciências da Saúde de Porto Alegre (UFCSPA), Disciplina de Otorrinolaringologia (ORL) e Programa de Pós-Graduação em Pediatria, Porto Alegre, RS, Brazil. E-mail: jlubianca@ufcspa.edu.br (J.F. Lubianca Neto).