An audit of paediatric tracheostomies in Port Harcourt Nigeria

Abstract

Background: Airway management in the paediatric age group may be challenging to both the 
anesthetists and otolaryngologists. Clinicians usually consider tracheostomy only in circumstances 
where no other alternative is available because of its associated complications. Objective: This study 
was carried out to establish the pattern of paediatric tracheostomies in our setting. It will also highlight 
the common indications, complications and outcomes of tracheostomized paediatric patients. Lastly, it 
will obtain baseline data for future studies. Patients and methods: A retrospective case series of all 
paediatric patients, 5 days old to16 years who had tracheostomies in the department of Ear, Nose and 
Throat (ENT) surgery of University of Port Harcourt Teaching Hospital (UPTH) and Rex Medical centre 
(RMC) both in Port Harcourt, Nigeria, from January 2002 to December 2011. Patient records were 
analyzed for demographic data, indications for tracheostomy, types of tracheostomy, operative 
technique, complications of tracheostomy and outcome. Results: A total of 152 patients had 
tracheostomy within the study period. There were 104 males and 48 females with M: F ratio of 2.2:1. The 
age range was 5 days to 16 years with a mean of 4.64 (SD ± 2.35) years. Age group 3-5 years accounted 
for majority (n=95, 62.50%) of the cases. Upper airway obstruction was the commonest (n=147, 96.71%) 
indication for tracheostomy and foreign bodies in the larynx ranked highest (n=125, 82.24%) as an 
etiological factor of the upper airway obstructions. The commonest post-operative complication was 
post-decannulation airway obstruction (n=22, 14.47%) and there was no mortality associated with the 
tracheostomies done in this series. Conclusion: Paediatric tracheostomy is an important procedure that 
continues to be a standard surgical technique for paediatric airway management in spite of its 
associated complications. Upper airway obstruction due to laryngeal foreign bodies was the 
commonest indication in our setting whereas; post-decannulation airway obstruction was the 
commonest complication in our series.