Tracheotomy in Children: Experience from a Sub-Saharan Pediatric Hospital

Introduction: Pediatric tracheostomy is a crucial surgical procedure that ensures airway patency in children suffering from a variety of respiratory pathologies. In recent decades, this procedure has gained importance, particularly due to significant advances in neonatal and pediatric intensive care. Objective: The aim of the study was to describe the epidemiological, clinical features, complications, indications, and sequelae of tracheotomies in children at the ENT Department of National University Hospital of Fann and Albert Royer Children’s Hospital in Dakar, Senegal. Patients and method: We performed a retrospective analytical multicenter and descriptive study at ENT Department of Fann teaching and neonatal services at Albert Royer Hospital in Dakar, Senegal, over a period of 4 years (from January 1, 2019 to December 31, 2022), including the records of children of both sexes, aged 0 to 15 years and hospitalized in NHN’s ENT and. Data was entered on World and Excel 2016, data processing and analysis on the Sphinx software (e.g., chi-square, t-test, etc.) . Results: We recorded Thirty-five (35) cases of tracheotomy. The average age was 6.50 years with 8-day and 15-year extremes. The sex ratio was 1.7. The highest number of tracheotomies was recorded in 2022 with 12 cases. Laryngeal dyspnea was the most frequent reason for consultation with 70.6%, followed by the laryngeal stridor with 23.5%. The clinical examination found signs of struggle in 33% of cases and Stage 3 and 4 dyspnea as per Chevalier Jackson and Pineau classification . In the indications of tracheotomy, acquired tracheal stenosis was more frequent with 22.8% of cases and malignant tumor pathologies with 20%. Emergency tracheotomy was performed in 25 patients (71.4%) . The scheduled tracheostomy was performed in 10 patients, or 28.6%. General anesthesia was used in 71% of cases and local anesthesia in 29%. The cutaneous incision was vertical in 29 patients, 82.9% and transverse in 6 patients, 17.1%. In the tracheotomy, 9 patients (25.7%) had complications. For 9 patients tracheotomized (25.7%), the evolution was towards death. De-cannulation was achieved in 10 patients (28.6%) . The average decannulation time is 34 days with extremes of 1 day and 210 days. Nine patients or 25.7% of the cases died with their cannulas still in place. Conclusion: Regardless of the indication, tracheotomy is a life-saving procedure whose utility and effectiveness are well-established. Mastery of the technique, rigorous monitoring, and postoperative care are the key factors in minimizing the risk of complications.