Çocuk Yoğun Bakım Ünitesinde Trakeostomi Uygulamaları, Tek Merkez Deneyimi

Öz

Amaç: Trakeostomi çocuk yoğun bakım ünitesinde (ÇYBÜ) en sık uygulanan cerrahi girişimlerden biridir. Önceleri laringeal obstruksiyonu olan hastalarda acile tedavi yöntemi iken günümüzde daha çok elektif şartlarda uzamış mekanik ventilasyon süresi olan hastalarda uygulanmaktadır. Bu çalışmada, ÇYBÜ' mizde trakeostomi uygulanan hastaları, endikasyonları, ve komplikasyonları değerlendirmeyi amaçladık. Gereç ve Yöntem: Bu retrospektif çalışma Şubat 2018'den Nisan 2022'ye kadar gerçekleştirildi. Veriler hasta kayıtlarından toplandı ve analiz edildi. Bulgular: Kırk üç hasta çalışmaya alındı. Hastaların ortanca yaşı 5±4.99 (aralık 0-17 yaş) ve 30 hasta (%69.8) erkek idi. Dört yıllık çalışma döneminde trakeostomi oranı %2,4 ve dekanülasyon oranı %7 bulundu. hastaların hepsi ev tipi ventilatör ile eve taburcu edildi. En sık trakeostomi uygulama endikasyonu uzamış mekanik ventilasyondu (%88.3). Trakeostomi öncesi entübasyon süresi ortanca 111.6±57.22 (aralık 0-240) gündü. Çalışmada yoğun bakım izlem sürecinde cerrahi komplikasyon izlenmedi. Tüm hastalar yoğun bakımdan ev tipi mekanik ventilatör ile taburcu edildi. Taburculuk sonrası poliklinik kontrol sayısı ortancası 7.28±1.89 (aralık 3-10), yıllık kanül değişim sayısı ortancası 3.62±0.76 (aralık 1-5) idi. 14 hasta ÇYBÜ'den taburcu olduktan sonra kaybedildi. Hiçbir hastanın ölüm sebebi trakeostomi komplikasyonu değildi. Ölüm zamanının ortancası ÇYBÜ' den taburculuk sonrası 30±13.97 (aralık 11-56) gündü. Hayatta kalan ve ölen hastalar yaş, mekanik ventilasyon süresi ve ÇYBÜ' de kalış süresine göre karşılaştırıldığında arada anlamlı fark bulunmadı (sırasıyla p=0.291, p=0.115 ve p=0.291). Sonuç: Bizim çalışmamızda uzun mekanik ventilasyon süresi trakeostomi açılması için en sık endikasyon olup sonucumuz literatür ile uyumludur. Trakeostomi zamanlaması uzun olsa bile mortalite ile arada anlamlaı ilişki görülmemiştir.

Anahtar Kelimeler

• Çocuk yoğun bakım
• trakeostomi
• dekanülasyon
• uzamış mekanik ventilasyon

Tracheostomy Practices in Pediatric Intensive Care Units, Single Center Experience

Öz

Background/Aims: Tracheostomy is one of the most frequently performed surgical procedures in the pediatric intensive care unit (PICU). While it used to be an emergency treatment method in patients with laryngeal obstruction, it is now mostly used in patients with prolonged mechanical ventilation under elective conditions. In this study, we aimed to evaluate patients who underwent tracheostomy in our PICU, indications, and complications. Methods: This retrospective study was conducted from February 2018 through April 2022. Data was collected from the patient’s records and analyzed. Results: Forty-three patients were included in the study. The median age of the patients was 5±4.99 (0-17 years) and 30 patients (69.8%) were male. During the four-year study period, the tracheostomy rate was 2.4% and the decannulation rate was 7%. All of the patients were discharged home with the home ventilator. The most common indication for tracheostomy was prolonged mechanical ventilation (88.3%). The median time of mechanical ventilation before tracheostomy was 111.6±57.22 (range 0-240) days. No surgical complications were observed during the PICU follow-up. All patients were discharged from PICU with a home-type mechanical ventilator. The median number of outpatient controls after discharge was 7.28±1.89 (range 3-10), and the median number of annual cannula replacements was 3.62±0.76 (range 1-5). 14 patients died after discharge from the PICU. None of the patients died due to tracheostomy complications. The median time of death was 30±13.97 (range 11-56) days after discharge from the PICU. When the surviving and deceased patients were compared according to age, mechanical ventilation time, and length of stay in the PICU, no significant difference was found (p=0.291, p=0.115, and p=0.291, respectively). Conclusions: In our study, long mechanical ventilation time was the most common indication for tracheostomy, and our result is consistent with the literature. Although the timing of tracheostomy was long, no significant correlation was observed with mortality.

Anahtar Kelimeler

• pediatric intensive care
• tracheostomy
• decannulation
• prolenged mechanical ventilation

Kaynakça

1. 1. Graamans K, Pirsig W, Biefel K. The shift in the indications for the tracheotomy between 1940 and 1955: a historical review. J Laryngol Otol 1999;113: 624–27.
2. 2. Kost KM. Endoscopic percutaneous dilatational tracheotomy: a prospective evaluation of 500 consecutive cases. Laryngoscope 2005;115: 1–30.
3. 3. Jackson C. Tracheotomy. Laryngoscope 1909;19:285–90.
4. 4. Lassen HC. The poliomyelitis epidemic of 1952 in Copenhagen: 349 cases with respiratory insufficiency and deglutition paralysis. Presse Med 1953;19:1667–70.
5. 5. Mahadevan M, Barber C, Salkeld L, Douglas G, Mills N. Pediatric tracheotomy: 17 year review. Int J Pediatr Otorhinolaryngol 2007;71:1829-35
6. 6. Davis MG. Tracheostomy in children. Paediatr Respir Rev 2006;7:206-09
7. 7. Parrilla C, Scarano E, Guidi ML, Galli J, Paludetti G. Current trends in paediatric tracheostomies. Int J Pediatr Otorhinolaryngol 2007;71:1563-67
8. 8. Carron JD, Derkay CS, Strope GL, Nosanchuk JE, Darrow DH. Pediatric tracheotomies: changing indications and outcomes. Laryngoscope 2000;110:1099-1104

9. 9. Charles GD. Tracheostomy: Why, When, and How? Respir Care 2010;55:1056-68.
10. 10. Berry JG, Graham RJ, Roberson DW, et al. Patient characteristics associated with in-hospital mortality in children following tracheotomy. Arch Dis Child 2010;95:703-10.
11. 11. Kremer B, Botos-Kremer AI, Eckel HE, Schlöndorff G. Indications, complications, and surgical techniques for pediatric tracheostomies–an update. J Pediatr Surg 2002;37:1556-62.
12. 12. Berry JG, Graham DA, Graham RJ, et al. Predictors of clinical outcomes and hospital resource use of children after tracheotomy. Pediatrics 2009;124:563-72.
13. 13. Watters KF. Tracheostomy in Infants and Children. Respir Care. 2017;62:799-825.
14. 14. Douglas CM, Poole-Cowley J, Morrissey S, Kubba H, Clement WA, Wynne D. Paediatric tracheostomy—an 11-year experience at a Scottish paediatric tertiary referral center. Int J Pediatr Otorhinolaryngol 2015;79:1673–76
15. 15. Ishaque S, Haque A, Qazi SH, Mallick H, Nasir S. Elective Tracheostomy in Critically Ill Children: A 10-Year Single-Center Experience From a Lower-Middle Income Country. Cureus. 2020;12:9080.
16. 16. Kamit Can F, Anil A, Anil M, et al. The outcomes of children with tracheostomy in a tertiary care pediatric intensive care unit in Turkey. Türk Pediatri Arşivi. 2018;53:177–84.
17. 17. Adly A, Youssef TA, El-Begermy MM, Younis HM. Timing of tracheostomy in patients with prolonged endotracheal intubation: a systematic review. Eur Arch Otorhinolaryngol. 2018;275:679-690.
18. 18. Holloway AJ, Spaeder MC, Basu S. Association of timing of tracheostomy on clinical outcomes in PICU patients. Pediatr Crit Care Med. 2015;1:52-8.
19. 19. McPherson ML, Shekerdemian L, Goldsworthy M, et al. A decade of pediatric tracheostomies: indications, outcomes, and long term prognosis. Pediatr Pulmonol 2017;52:946–53
20. 20. Ozmen S, Ozmen OA, Unal OF. Pediatric tracheotomies: 37-year experience in 282 children. Int J Pediatr Otorhinolaryngol, 2009;73:959–61
21. 21. Schweiger C, Manica D, Becker CF et al. Tracheostomy in children: a ten-year experience from a tertiary center in southern Brazil. Braz J Otorhinolaryngol 2017;83:627–32
22. 22. Ogilvie LN, Kozak JK, Chiu S et al. Changes in pediatric tracheostomy 1982–2011: a Canadian tertiary children’s hospital review. J Pediatr Surg 2014;9:1549–53
23. 23. Joseph RA. Tracheostomy in infants: parent education for home care. Neonatal Netw. 2011;30:231-42.
24. 24. Bonvento B, Wallace S, Lynch J, Coe B, McGrath BA. Role of the multidisciplinary team in the care of the tracheostomy patient. J Multidiscip Healthc. 2017;10:391-98.
25. 25. Mitchell RB, Hussey HM, Setzen G, et al. Clinical consensus statement: tracheostomy care. Otolaryngol Head Neck Surg. 2013;148:6-20.
26. 26. Volsko TA, Parker SW, Deakins K, et al. AARC Clinical Practice Guideline: Management of Pediatric Patients With Tracheostomy in the Acute Care Setting. Respir Care. 2021 ;66:144-55.
27. 27. Dursun O, Ozel D. Early and long-term outcome after tracheostomy in children. Pediatr Int 2011;53:202–6.
28. 28. Karapınar B, Arslan MT, Ozcan C. Pediatric bedside tracheostomy in the pediatric intensive care unit: six-year experience. Turk J Pediatr 2008;50:366-72.
29. 29. Jalil CY, Villarroel SG, Barañao GP, Briceño LL, Lara PA, Méndez R M. Pediatric tracheostomy tube change. Rev Chil Pediatr. 2020;91:691-96.
30. 30. Zebda D, Anderson B, Huang Z, Yuksel S, Roy S, Jiang ZY. Early Tracheostomy Change in Neonates: Feasibility and Benefits. Otolaryngol Head Neck Surg. 2021; 165:716-721.
31. 31. Tolunay I, Yıldızdas¸ RD, Horoz OO et al. An assessment of pediatric tracheostomy in a pediatric intensive care unit. CAYD 2015;2:60–4