Çocuk Yoğun Bakım Ünitesinde Trakeostomi Uygulamaları, Tek Merkez Deneyimi

Year 2023, Volume: 13 Issue: 5, 1008 - 1012, 30.09.2023

Merve Havan , Ali Tunç , Murat Ersoy , Mahmut Aslan , Arman Api

https://doi.org/10.16899/jcm.1355300

Abstract

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.

Keywords

Çocuk yoğun bakım, trakeostomi, dekanülasyon, uzamış mekanik ventilasyon

Tracheostomy Practices in Pediatric Intensive Care Units, Single Center Experience

Abstract

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.

Keywords

pediatric intensive care, tracheostomy, decannulation, prolenged mechanical ventilation

Ethical Statement

This study was approved by the Mersin University Rectorate, Clinical Research Ethics Committee. (Date:15.12.2021. Decision Number: E-1854281).

Supporting Institution

None

Thanks

The authors thank to the nurses and medical staff of the PICU and operating room department. We would like to thank the patients' families for allowing the information to be shared.

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