Tracheotomy in Pediatric Trauma

To describe the role of tracheotomy in the care of injured children.

The use of tracheotomy appears to be increasing in pediatric trauma, with up to a third performed in the first week of hospitalization. Earlier timing of tracheotomy has been associated with improved in-hospital outcomes in retrospective cohorts, but there is a lack of high-quality evidence to support these findings. Patients with airway injury or obstruction may have the shortest requirement for tracheostomy use – many decannulated during the index admission. Long-term tracheostomy studies report a significant cost burden to families, both from at-home care and additional hospital admissions. Tracheostomy-dependent children are at significant risk for mortality.

The role of tracheotomy in pediatric trauma patients is controversial. Those with isolated airway injury may have the best outcomes. Tracheotomy in children with neurologic injury may hasten ventilator weaning, but the long-term impact of this procedure must be considered.