Long term issues and solution recommendations in children with tracheostomy

INTRODUCTION: Tracheostomy is a surgical procedure that has existed since ancient times and has seen an increase in frequency over the years. While tracheostomy has many advantages, it is also a procedure with a high rate of complications. The majority of the literature on pediatric tracheostomy consists of descriptive studies. It has been observed that there is a lack of adequate studies related to children with tracheostomy in our country. This study aims to examine the medical data of children with tracheostomy, contribute to the literature on this topic in our country, determine long-term complications, prevent the occurrence of complications, and provide solution recommendations for the treatment phase if complications have developed. MATERIAL AND METHOD: The sample of our study consists of 74 pediatric patients aged between 1 month and 18 years, who were monitored with a diagnosis of tracheostomy status at Bezmialem Vakif University Faculty of Medicine, Department of Child Health and Diseases between 2000-2023. Medical information obtained from patients' families and the hospital registration system has been retrospectively evaluated. Demographic characteristics of the patients and their families, indications for tracheostomy, the number of years they have had a tracheostomy, characteristics of the used cannulas, bronchoscopy findings if any, hospitalization frequencies, underlying primary diseases, types of equipment at home, presence of dysphagia symptoms, educational status of home caregivers, and complications experienced by the patients related to tracheostomy were recorded. Relationships between the number of caregivers and educational status with complications, relation between the center where tracheostomy was performed and care education, relation between diagnosis and indication, the relation between cannula type and complications, relationship between diagnosis and mechanical ventilator use, frequency of hospitalization and dysphagia, colonization presence and aspiration type, and frequency of aspiration and treatment for hypersalivation were examined. RESULTS: 52.7% of the 74 patients included in the study are over the age of 5. The gender distribution of the patients is 54.1% male and 45.9% female. The most common primary diagnosis in our patients was genetic and syndromic diseases with 37.8%, followed by cerebral palsy with 29.7%. The most common indication for tracheostomy was prolonged ventilation at 66.2%, followed by airway protective tracheostomy at 24.3%. 12.1% of our patients have only one caregiver, and the caregiver is often the mother (87.8%). After tracheostomy, 35.1% of patients had reduced hospital admissions and ICU stay frequencies. 89.2% of the patients had complications. Granulation tissue formation was identified in 52.7% of the patients as a complication. 2.7% of our series was decannulated, and 6.8% are in the decannulation phase. Our series had a mortality rate of 4.1%, which is consistent with the literature. 77.8% of those with only one caregiver had complications, while 90.8% of those with more than one caregiver had complications, with no statistically significant difference (p=0.249). 74% of our series have dysphagia. 30.9% of those with dysphagia stated that their hospital admission frequency decreased after tracheostomy, while 20% stated it increased. For those without dysphagia, 47.4% stated that their hospitalization frequency decreased after tracheostomy, while 10.5% said it increased. At the same time, it was found that 50% of the patients received treatment due to hypersalivation caused by dysphagia. In our study, accidental decannulation was detected in 41.4% of those with PVC cannula type and 58.6% of those with silicone, with a statistically significant difference (p=0.023). 95.9% of caregivers received training, most frequently in aspiration. When the education received was compared according to the center where tracheostomy was performed; 40.5% of those opened in an external center received four of the training, and 50% received all training. 9.4% of those whose tracheostomy was opened at Bezmialem Vakif University received four of the training, and 90.6% received all training, and there was a statistically significant difference (p<0.001). 63.2% of those with aspiration frequency <1 hour, 63.6% of those with 1-3 hours, 21.4% of those with 3-4 hours, and 14.3% of those >4 hours received hypersalivation treatment, and a statistically significant difference was found (p<0.007). Clean aspiration technique was found in 82.7% of those, modified clean in 68.4% and sterile in 66.6% had colonization, and there was no statistically significant difference (p=0.406). CONCLUSION AND RECOMMENDATIONS: In our patients, the most common indication for tracheostomy, consistent with the literature, was prolonged ventilation at 66.2%, followed by airway protective tracheostomy at 24.3%. It was observed that most of our patients have chronic diseases such as cerebral palsy, chronic respiratory failure, and neurological disease. This leads to prolonged tracheostomy monitoring and an increase in complications. Methods should be found to minimize complications and ensure airway management in these children. It is believed to be essential for patients to be monitored at regular intervals by a multidisciplinary team and for families to be given detailed training on tracheostomy care. It is also thought that creating projects that provide psychological and social support to families will reduce complications and the burden they bring. Keywords: Tracheostomy, indication, complication, solution recommendations.