Yenidoğan Yoğun Bakım Ünitesinde Trakeostomi Uygulamaları

Abstract

Amaç: Bu araştırmada ünitemizde trakeostomi açılmış olan hastaların endikasyonları, erken ve uzun dönem sonuçlarının belirlenmesi amaçlanmıştır.

Gereçler ve Yöntem: Bu çalışmada Ocak 2013- Aralık 2015 arasında Zekai Tahir Burak Kadın Sağlığı Eğitim Araştırma Hastanesi Yenidoğan Yoğunbakım kliniğinde izlenen ve trakeostomi açılmış olan 11 hastanın geriye dönük kayıtları incelenmiştir. Hastaların gestasyonel yaşları, doğum ağırlıkları, trakeostomi endikasyonları, trakeostomi öncesi entübe kaldıkları gün sayısı, komplikasyonlar, komorbiditeler, mortalite oranları, mevcut klinik durumları kaydedilmiştir.

Bulgular: Hastaların gestasyon yaşı ortanca 32 hafta (23-39), doğum ağırlığı 1470 gr (550-3180) idi. Trakeostomi öncesi entübe kalma süresi ortanca 130 gün (1-290) idi. Trakeostomi açılma günü 73 (1-190) gün saptandı. Trakeostomi açılma sebepleri 1 hastada konjenital laringeal anomali, dört hastada prematürite komplikasyonları (bronkopulmoner displazi, subglottik stenoz), üç hastada nöromüsküler güçsüzlük (asfiksi, metabolik hastalık, myotonik distrofi), bir hastada Beckwith-Wideman sendromu, bir hastada artrogyropozis multipleks, bir hastada Arnold-Chiari malformasyonu nedeniyle uzamış mekanik ventilasyon idi. Trakeostomi sonrası üç (%27,2) hasta mekanik ventilatörden ayrıldı. Bu hastalarda mekanik ventilatörden ayrılma süresi ortanca 18,6 (4-40) gün olarak saptandı. Ortanca hospitalizasyon süresi 180 (1-350) gün olup sekiz hasta (%72,7) takip süresince primer hastalıkları nedeniyle kaybedildi. İki (%18,1) hasta taburcu edildi. Hastaların üçüne (%27,2) ikinci kez trakeostomi açılması gerekti, iki hastaya kazara dekanulasyon nedeniyle, bir hastaya striktür nedeniyle revizyon yapıldı. Bir hasta taburculuk sonrası izleminde trakeotomisi kapatıldı.

Sonuç: Günümüzde uzun süreli entübasyon ve sekelleri pediyatrik yaş grubundaki trakeostominin en önemli endikasyonu haline gelmiştir.

Keywords

• Komplikasyonlar,trakeostomi,yenidoğan

Tracheostomy in Neonatal Intensive Care Unit

Abstract

Aim: In this study with reviewing the tracheostomy cases at our institution, we aimed to determine and discuss the tracheotomy indications and early and long term outcomes.  

Materials and Method: In this study, clinical records of 11 tracheostomy cases at Zekai Tahir Burak Maternity and Teaching Hospital NICU between January 2013 and December 2015 were reviewed retrospectively. The patients’ gestational ages, birth weights, tracheotomy indications, duration of mechanical ventilation before tracheostomy, complications, comorbidities, mortality rate, and actual clinical condition were recorded.

Results: Gestational ages were median 32 weeks (23-31 weeks), birth weights were 1470 gr (550-3180). Prolonged intubation period was median 130 days (1-190). Age on tracheotomy ranged from 1 to 190 days (median 73 days). Their diagnoses were congenital laryngeal anomaly; and prolonged mechanical ventilation due to complications of prematurity (bronchopulmonary dysplasia, subglottic stenosis), neuromuscular weakness (asphxia, metabolic disorder, myotonic dystrophy), Beckwith-Wideman syndrome, artrogyropozis multiplex, Arnold-Chiari malformation. After tracheostomy three (27.2%) patients weaned and mechanical ventilation was discontinued. In this cases, median duration of weaning was 18.6 days (4-40).  The length of hospitalization was median 180 days (1-350) and eight infants (72.7%) were lost before they discharged. Two (%18.1) infants were discharged. Revision was made three infants due to decanulation and tracheal stricture. Decannulation was implemented in one patient after discharge.

Conclusion: Long-term intubation and its sequelae have now become one of the most important indications for tracheostomies in the paediatric age group.

Keywords

• Complications,tracheostomy,newborn

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