Pediatrik Trakeostomi: 25 Vakanın Endikasyon ve Komplikasyon AnaliziPediatric Tracheotomy: Indication and Complication Analysis of 25 Cases

Yıl 2015, Cilt: 5 Sayı: 2, 0 - 0, 01.06.2015

Mansur Doğan , İsmail Önder Uysal , Salim Yüce , Ahmet Sami Güven , Kerem Polat , Mehmet Arpacık , Fevzi Can

Öz

Amaç: Bu çalışmada daha önceden farklı nedenlerle trakeotomi uygulanmış 25 pediatrik hasta ele alındı. Endikasyonlar, komplikasyonlar ve elde edilen sonuçlar değerlendirildi. Çocuklarda trakeotomi uygulaması hakkında deneyimlerimizi paylaşmayı ve özellikle kulak burun boğaz ve pediatri kliniklerinde görev yapan hekimlere bu konu ile ilgili fikir vermeyi amaçladık.

Gereç ve Yöntem:  2006 ve 2015 yılları arasında trakeotomi uygulanan 25 çocuk hasta (n=17, 68% erkek; n=8, 32% kız) retrospektif olarak değerlendirildi. Trakeotomi endikasyonları, erken ve geç komplikasyonlar, dekanülasyon süresi ve trakeotomi sonrası akıbetleri kaydedildi.

 

Bulgular: En sık trakeotomi endikasyonu uzun entübasyon süresi idi (n=19, 76%). Solunum yetmezliği (n=9, 36%), nöromusküler hastalıklar (n=4, 16%), büyük cerrahi sonrası süreç (n=3, 12%) ve enfeksiyon / sepsis ilişkili hastalıklar (n=2, 3.8%) uzun entübasyona neden olan durumlardı. Trakeotomi 6 (%24) çocuk hastada üst hava yolu obstrüksiyonu nedeni ile uygulandı. Ortalama entübasyon süresi 18.7±15 gün idi. Erken ve geç komplikasyon oranları her ikisi de %8 idi. Dekanülasyon başarısına 8 (%32) çocukta ulaşıldı. Trakeotomi sonrası ortalama dekanülasyon süresi 29.4±20.8 gün idi. Trakeotomi sonrası hayatını kaybeden hasta sayısı 12 (48%) idi.

Sonuç: Biz çocuklarda trakeotomi endikasyonları, komplikasyonları ve sonuçlarını ele alarak bu konuda güncel bir bilgi sunmayı hedefledik. 

Aim: In this study 25 pediatric patients that underwent tracheotomy due to different reasons were evaluated and the indications, complications due to tracheotomy and the results after the procedure were detected. We wanted to share our experience about the use of tracheotomy in children and aimed to give an idea to clinicians especially those working in Otolaryngology and Pediatric departments.

Materials and Methods: Twenty five children patients (n=17, 68% boys; n=8, 32% girls) applied tracheotomy between 2006 and 2015 were analyzed retrospectively. The indications of tracheotomy, early and late complications, the time of decannulation and results after tracheotomy were recorded.

Findings: Prolonged intubation was the most common indication (n=19, 76%) for tracheotomy. Respiratory failure (n=9, 36%), neuromuscular diseases (n=4, 16%), postoperative period following major surgery (n=3, 12%) and infection/sepsis related diseases (n=2, 3.8%) were the causes of prolonged intubation. Tracheotomy was performed for upper airway obstruction in 6 (24%) children. The mean intubation time was 18.7±15 days. Early and late complication rates were 8% and 8%, respectively. Decannulation success was observed in 8 children (32%). Mean decannulation time after tracheotomy was 29.4±20.8 days in the patients. The number of patients died after tracheotomy was 12 (48%).

Conclusion: We tried to detect the indications, complications due to tracheotomy and the results after the procedure in children and aimed to give an up-to-date information.

Kaynakça

• Meirelles RC, Neves-Pinto RM. Historia da traqueotomia. Rev Soc Ororhinolaryngol. 2005;5:4-9.
• Hoskote A, Cohen G, Goldman A, Shekerdemian L. Tracheostomy in infants and children after cardiothoracic surgery: indications, associated risk factors, and timing. J Thorac Cardiovasc Surg. 2005;130(4):1086-93.
• Lindman JP, Morgan CE (2001) Tracheostomy, Updated on June 7, 2010.
• Carron JD, Derkay CS, Strope GL, Nosonchuk JE, Darrow DH. Pedaitric tracheotomies: changing indications and outcomes, Laryngoscope. 2000;110(7):1099–1104.
• Rocha EP, Dias MD, Szajmbok FE, Fontes B, Poggetti RS, Birolini D. Tracheostomy in children: there is a place for acceptable risk. J Trauma. 2000;49(3):483–5.
• Lewis CW, Carron JD, Perkins JA, Sie KC, Feudtner C. Tracheotomy in pediatric patients: a national perspective. Arch Otolaryngol Head Neck Sur. 2003;129(5):523–529.
• Rehm, RS, Rohr JA. Parents’, nurses’, and educators’ perceptions of risks and benefits of school attendance by children who are medically fragile/technology-dependent. J Pediatr Nurs. 2002;17(5):345-53.
• Waddell A, Appleford R, Dunning C, Papsin BC, Bailey CM. The Great Ormond Street protocol for ward decannulation of children with tracheostomy: increasing safety and decreasing cost. Int J Pediatr Otorhinolaryngol. 1997;39(2):111-8.
• Donnelly MJ, Lacey PD, Maguire AJ. A twenty year (1971-1990) review of tracheostomies in a major paediatric hospital. Int J Pediatr Otorhinolaryngol. 1996;35(1):1-9.
• Berry JG, Graham RJ, Roberson DW, Rhein L, Graham DA, Zhou J, O’Brien J, Putney H, Goldmann DA. Patient characteristics associated with in-hospital mortality in children following tracheotomy. Arch Dis Child. 2010;95(9):703–710.
• Kremer B, Botos-Kremer AI, Eckel HE, Schlondorff G. Indications, complications, and surgical techniques for pediatric tracheostomies-an update. J Pediatr Surg. 2002;37(11):1556-62.
• Arcand P, Granger J. Pediatric tracheostomies: changing trends. J Otolaryngol. 1988; 17(2): 121-125.
• Hadfild PJ, Lloyd-Faulconbridge RV, Almeyda J, Albert DM, Bailey CM. The changing indications for paediatric tracheostomy. Int J Pediatr Otorhinolaryngol. 2003;67(1):7-10.
• Karapınar B, Aslan MT, Ozcan C. Pediatric bedside tracheostomy in the pediatric intensive care unit: sixyear experience. Turk J Pediatr. 2008; 50(4): 366-372.
• Süslü N, Ermutlu G, Akyol U. Pediatric tracheotomy: comparison of indications and complications between children and adults. Turk J Pediatr. 2012; 54(5): 497-501.
• Dougherty L, Lister S, The Royal Marsden Hospital Manual of Clinical Nursing Procedures, 8th ed. Wiley-Blackwell, Oxford. 2011.p.539-608.
• Day T, Iles N, Griffiths P. Effect of performance feedback on tracheal suctioning knowledge and skills: randomized controlled trial, J. Adv. Nurs. 2009;65(7):1423–1431.
• Berry JG, Graham DA, Graham RJ, Zhou J, Putney HL, O'Brien JE, Roberson DW, Goldmann DA. Predictors of clinical outcomes and hospital resource use of children after tracheotomy. Pediatrics. 2009;124(2):563-72.
• Sugerman HJ, Wolfe L, Pasquale MD, Rogers FB, O'Malley KF, Knudson M, DiNardo L, GordonM, Schaffer S. Multicenter Randomized, prospective trial of early tracheostomy. J Trauma. 1997;43(5):741–7.
• Gianoli GJ, Miller RH, Guarisco JL. Tracheostomy in the first year of life. Ann Otol Rhinol Laryngol. 1990; 99(11): 896-901.
• Schlessel JS, Harper RG, Rappa H, Kenigsberg K, Khanna S. Tracheostomy: acute and long-term mortality and morbidity in very low birth weight premature infants. J Pediatr Surg. 1993;28(7):873-76.
• Enç Y, Aydemir N, Biçer Y, Yurtseven N, Orhan G, Özay B, Ayoglu U, Görür A, Altın F, Çiçek S. Pediatrik ameliyat sonrası kardiyak yoğun bakımda trakeostomi endikasyonları ve sonuçları. Turkish J Thorac Cardiovasc Surg 2008;16(1):24-28.
• Wakeham MK, Kuhn EM, Lee KJ, McCrory MC, Scanlon MC. Use of tracheostomy in the PICU among patients requiring prolonged mechanical ventilation. Intensive Care Med. 2014;40(6):863-70.
• Holscher CM, Stewart CL, Peltz ED, Burlew CC, Moulton SL, Haenel JB, Bensard DD. Early tracheostomy improves outcomes in severely injured children and adolescents. J Pediatr Surg. 2014;49(4):590–92.