Fibroscopic-guided percutaneous dilatational tracheostomy in critically ill children: a single center observational study

Abstract

Abstract Background Percutaneous tracheostomy is rarely used in children due to limited experience and safety concerns, in contrast to adult patients where the overwhelming majority of tracheostomies are placed via the percutaneous route. To assess the feasibility of percutaneous dilatational tracheostomy (PDT) using the modified fibroscopic-guided Ciaglia technique, we prospectively recorded and analyzed all PDT procedures performed for persistent failure to wean from mechanical ventilation and inability to protect the airway in our pediatric intensive care unit. Results From January 2003 to March 2022, 27 children (median age 12, range 5–17, years; median weight 38, range 19.5–80 kg; median PRISM II 10, range 6–11) underwent a PDT for acute encephalitis (10 children), neurovascular disease (5 children), and other indications, using a Shiley cannula ranging from 5.5 to 7 mm internal diameter (ID) after a median length of mechanical ventilation of 13 (range 10–22) days. Early complications included a few minor events, and we did not observe significant peristomal granulation nor infection. Three patients required transient tracheal stenting for suprastomal collapse, and four others developed severe subglottis (1) or substromal tracheal stenosis (3). The overall in-hospital mortality was 27%. Among the long-term survivors, cannulas were removed in 85% of cases after a median length of tracheostomy of 47 (range 31–77) days. Conclusions PDT is feasible and could be an alternative option to traditional surgical tracheostomy in adolescents and children over the age of 5.