ABSTRACT
This chapter discusses the indications, techniques for insertion, and maintenance of a tracheostomy in infants. The indications for tracheostomy in neonates and infants can be broadly divided into three categories: prolonged ventilation, upper airway obstruction, and pulmonary toilet for mainly neurological patients with aspiration. Tracheostomy is recommended for patients requiring extended periods of ventilation to manage lung disease, such as bronchopulmonary dysplasia in premature infants, as well as to manage respiratory failure directly or indirectly, as a result of congenital neurologic, pulmonary and cardiovascular abnormalities. Tracheostomy was developed as an emergency procedure for acute airway difficulties, in many settings, most infants who need a tracheostomy already have an endotracheal tube in place. Decannulation usually is anticipated well in advance. Its timing depends largely on the indication for the tracheostomy. Decannulation is considered for the following: resolution of underlying airway abnormality; natural expansion of the airway with growth; and surgical procedures designed to open narrowed airways.
