B. Sarath Balaji

Data on tracheostomy in children are scarce in India. Hence, our study aimed to determine the indications, timing, complications, and outcomes of tracheostomy in a pediatric intensive care unit (PICU). We carried out a single-center ambispective study in children aged 1 month to 12 years undergoing tracheostomy in the PICU from February 2019 to April 2024. Data on age, gender, indications, complications, outcome, and follow-up of post-tracheostomy patients were collected and analyzed. One hundred and thirty-six patients underwent tracheostomy. Neurological illness (57.4%) was the reason for admission in the majority of children. Prolonged ventilation was the most common indication for tracheostomy (50%). The median (IQR) duration of ventilation before tracheostomy was 21 (14–27) days. The mean (SD) duration of weaning to “T piece” was 9.3 (7.8) days. Forty-six children died in the hospital due to primary illness and 4 (2.9%) tracheostomy-related deaths. Complications were observed in 58 (42.6%) children. Tracheal aspirate growth was observed in 58 (42.6%). Mothers were the primary caregivers in 127 (93.4%). The median (IQR) duration of PICU stay was 28 (20–43.5) days. Forty-nine (36%) children were decannulated. Tracheostomy is a safe procedure in the PICU, and the mortality is mainly due to underlying illness. Subramani S, Varadarajan P, Rangabashyam N, Jayaraman N, Balaji S, Rajajeyavel JM. Tracheostomy in Children: Experience from a Tertiary Care Center in South India. Indian J Crit Care Med 2025;29(7):592–596.

Flexible bronchoscopes are increasingly being used in diagnostic and therapeutic medicine and have obviated the need for and risks associated with general anesthesia. Here the authors present the case of a 2-y-old girl who was diagnosed with isolated pulmonary Langerhans cell histiocytosis by histopathology; a lung biopsy sample was obtained using a cryoprobe via a flexible bronchoscope. The girl was brought in with complaints of loss of weight, appetite loss, and rapid breathing for the past 2 mo. Examination revealed hypoxia, tachypnea, clubbing with failure to thrive, and bilateral crepitations on auscultation. Imaging studies showed ground-glass opacities with multiple cystic lesions in both lungs. A preliminary diagnosis of LCH was made, and transbronchial cryobiopsy was done via a flexible bronchoscope. Histopathology confirmed the diagnosis with Cluster of differentiation 1a (CD1a) staining. A flexible bronchoscope can be a useful tool for obtaining lung biopsy samples using a cryoprobe in children.