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Percutaneous tracheostomy in pediatric patients showed comparable complication risks to open surgical tracheostomy, highlighting feasibility with recommendations for careful patient selection and surgical expertise.

The following is a summary of “Percutaneous tracheostomy in the pediatric population: A systematic review,” published in the Februray 2024 issue of Pediatrics by Namavarian et al.

This study systematically consolidates existing literature by addressing the limited evidence and safety concerns surrounding percutaneous tracheostomy in the pediatric population.

A systematic review was executed, adhering to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Comprehensive searches across MEDLINE, EMBASE, CINAHL, and Web of Science databases were conducted to identify studies on pediatric percutaneous tracheostomy (age ≤18). Quality appraisal was performed using the Joanna Briggs Institute and ROBINS-I tools.

The review encompassed twenty-one articles involving 143 pediatric patients. Age distribution ranged from 2 days to 17 years, with the largest subgroup (n = 57, 40 %) comprising adolescents (aged 12 to 17 years). Primary indications for percutaneous tracheostomy included prolonged ventilation (n = 6), respiratory insufficiency (n = 5), and upper airway obstruction (n = 5). Notably, one-third of procedures (n = 47) were conducted at the bedside in intensive care units. Some studies reported surgical time (mean 13.8, SD = 7.8 minutes, n = 27) and duration from intubation to tracheostomy (mean 8.9, SD = 2.8 days, n = 35). Postoperative complications included tracheoesophageal fistula (n = 4, 2.8 %) and pneumothorax (n = 3, 2.1 %), with four cases requiring conversion to open tracheostomy.

Percutaneous tracheostomy in the pediatric population displayed comparable complication risks to open surgical tracheostomy in children and adolescents. It can be feasible, especially when conducted at the bedside in select cases. However, due consideration must be given to the differing anatomical factors in younger patients compared to adults. Hence, the researchers recommend reserving this procedure for adolescent patients with a slender body build, distinct and palpable anatomical landmarks, and a genuine need for tracheostomy. Emphasizing the importance of endoscopic guidance, the study group advocates for the involvement of a surgeon capable of converting to an open tracheostomy, if necessary.

Source: sciencedirect.com/science/article/abs/pii/S0165587624000107