Abstract

Objectives

The number of children established on tracheostomy long term ventilation (tr-LTV) is increasing (Brookes: Thorax 2019).However, there is little information on the outcome for infants undergoing tracheostomy for airway issues and the proportion of patientssubsequently needing tr-LTV.

Wedescribe indications, outcome of infants undergoing tracheostomy and need for tr-LTVat a regional pediatric center in the UK.

Methods

Analysis of children aged less than 12 months who had tracheostomy between April 2011 to December 2022. Demographic data, indications for tracheostomy, age atprocedure, length of hospital stay and the characteristics of children needing tr-LTV were analyzed.

Results

Of 99 infants who had tracheostomy, 56 (56.5%) required tracheostomy only and 43(43.4%) required tr- LTV. 15/43 (34.9%) infants had not undergone tracheostomy with the original purpose of delivering tr-LTV.

The median length of hospital stay in the tr-LTV group was significantly longer [201 days, range:54- 831 days] compared to infants who just had tracheostomy [62days (range 3-343 days)],p=<0.0001.

Infants in tr-LTV group were older at tracheostomy insertion (87days vs 122days,p=0.001). Mortality rate was 18%.

15(15.1%) infants who had their tracheostomy for airway problems subsequently required LTV to achieve hospital discharge. 12/15(80%) of these infants were premature or had neurogenetic conditions or both.

Conclusion

A fifth of patients needing tracheostomy for upper airway issues only also needed tr-LTV. Prematurity and neurogenic issues may predict need for tr-LTV. Multispecialty team discussion prior to tracheostomy particularly in infants with multisystem conditions is vital