Complex tracheal resection in children: Myths, reality and lessons learned.

Tracheal resection is an uncommon procedure in children. It was described many years ago and many surgeons still rely on historical reports when performing the procedure, despite the technological and clinical advancements achieved during the last decades. We consider complex tracheal resections those resections of 30 to 50% of tracheal length, corresponding to at least 6-7 rings. With proper intra and post-operative management, this surgery is safe in children. In this review, we focused on the experience with this procedure of 3 reference centers, with 49 patients operated. We present a management algorithm for these patients, describing pre-operative evaluations, decision on surgical approach, need of tracheotomy, type of intra-operative oxygenation, surgical steps, and post-operative care.

Tracheostomy in children: Recommendations for a safer technique.

Over the last few decades, tracheostomy has been increasingly performed in children with various complex and chronic conditions. We have seen a dramatic change in indications for tracheostomy in pediatric patients due to better survival of premature infants and those suffering from severe congenital anomalies. There is no consensus about the timing of tracheostomy in pediatric patients. Although percutaneous tracheostomy has become the standard of care for adults, there is not sufficient evidence to start performing it routinely in pediatric patients. The indications, preoperative considerations, and different procedures for tracheostomy in children are reviewed. Surgical tracheostomy is described step by step placing an emphasis on safety measures to minimize complications. There is also a great variability in tracheostomy care protocols in the literature. Post-operative tracheostomy care is discussed for the early and late post-operative periods. There is no general consensus on decannulation protocols, but prevailing expert opinion is presented. There is growing evidence in support for an interdisciplinary approach to pediatric tracheostomized patients. The focus of this paper is the review of the literature regarding safety improvement strategies from the surgical and post-operative point of view.