Tracheostomy Etiologies and Clinical Evaluation of Pediatric Intensive Care Patients: A Retrospective Study
Öz
Objective:Nowadays patients who are monitored at home and/or in the intensive care unit is growing with use of tracheostomy.In our study, it was aimed to examine the etiology and demographic data of tracheostomy opening, follow-up, complications, home/hospital palliative care, mortality and decannulation status.
Method:All patients with tracheostomy in the pediatric intensive care between the ages of 1month and 18years between January2021-December2021 were included.Data were obtained retrospectively from electronic files. Demographic data, reason and length of hospitalization, age and gender, Pediatric Risk of Mortality III Score, Glasgow Coma Score, admission site, tracheostomy indication and complication, number of extubation attempts, separation from mechanical ventilation, clinical and laboratory pathologies, family/palliative care, mortality and morbidity were examined in detail.
Results:The mean age of 34(6.48%) patients who underwent tracheostomy was 56.50±66.94 months, the length of stay was 232.15±195.86 days, and unfortunately 17(50%) of them died. 11(32.35%) of the survivors were discharged. The mean PRISM III score was 18.82±8.60.Pneumonia was the most common diagnosis in admission, 30(88.24%) patients had comorbidities.The mean of failed extubation was 1.41±0.98. No complications were observed in 31(91.18%).The most common indication was prolonged intubation time due to neurological problems 17(50%) and only 14(41.18%) patients continued to be followed at home after receiving family education.
Conclusion:Tracheostomy is safe and necessary in childhood. The main determinant of prognosis is the indication for tracheostomy and/or the presence of comorbidities. In patients who have undergone tracheostomy, the length of hospital stay can be reduced with the cooperation of their families.
Anahtar Kelimeler
Kaynakça
- 1- Can FK, Anıl AB, Anıl M, Gümüşsoy M, Çitlenbik H, Kandoğan T, Zengin N. Türkiye’de üçüncü basamak bir çocuk yoğun bakımda trakeostomi uygulanan çocukların sonuçları. Türk Pediatri Arşivi 2018; 53(3):177-84.
- 2- Trachsel D, Hammer J. Indications for tracheostomy in children. Paediatric Respiratory Review 2006; 7(3):162-8.
- 3- Midwinter KI, Carrie S, Bull PD. Paediatric tracheostomy: Sheffield experience 1979-1999. The Journal of Laryngology and Otology 2002; 116(7):532-35. 4- Acar B, Acar M, Yıldız E, Karaşen RM. Çocuk Trakeostomi: Endikasyonlar, Komplikasyonlar ve 20 Olgunun İncelenmesi. Turgut Özal Tıp Merkezi Dergisi 2014; 211:41-3.
- 5- Kaygusuz U, Kayalı Dinç AS, Dinç T. Pediatrik Trakeotomi Deneyimimiz: Ameliyathanede mi, Yoğun Bakımda mı Açalım? Güncel Pediatri 2014; 2: 59-62.
- 6- Wetmore RF, Handler SD, Potsic WP. Paediatric tracheostomy:experience during the past decade. Annals of Otology, Rhinology and Laryngology 1982; 91:628-32.
- 7- Carron JD, Derkay CS, Strope GL, Nosonchuk JE, Darrow DH, Pediatric tracheostomies: changing indications and outcomes. Laryngoscope 2000; 110: 1099-1104.
- 8- 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. Archives in Diseases in Childhood 2010; 95:703-10.
- 9- Kremer B, Botos-Kremer AI, Eckel HE, Schlöndorff G. Indications, complications, and surgical techniques for pediatric tracheostomies–an update. Journal of Pediatric Surgery 2002; 37:1556-62.
- 10- Wood D, McShane P, Davis P. Tracheostomy in children admitted to paediatric intensive care. Archives in Diseases in Childhood 2012; 97: 866–900.
- 11- Ertugrul I, Kesici S, Bayrakci B, Unal OF. Tracheostomy in pediatric intensive care unit: When and Where? Iranian Journal of Pediatrics 2016; 26:e2283.
- 12- Mahafza T, Batarseh S, Bsoul N, Massad E, Qudaisat I, Al-Layla AE. Early vs. late tracheostomy for the ICU patients: Experience in a referral hospital. Saudi Journal of Anaesthesia 2012; 6(2):152-4.
- 13- Dursun A, Tekerek NÜ, Akyıldız B. Çocuk yoğun bakım ünitesinde trakeostomi açılan olguların değerlendirilmesi: Mekanik ventilatörden ayrılma ve Dekanülasyon Sonuçlarımız. Türkiye Çocuk Hastalıkları Dergisi 2018; 12(2):74-8.
- 14- Fidancı K, Parlak A. Çocuklarda Tam Kan İncelemesi. In: Yeşilkaya Ş, Özenç S, Babacan O, Yeşilkaya E, editors. Aile Hekimliğinde Sağlam Çocuk İzlemi. Ankara, 2013: 88-91.
- 15- Dursun O, Ozel D. Early and long-term outcome after tracheostomy in children. Pediatrics International: official journal of the Japan Pediatric Society 2011; 53: 202–6.
- 16- Da Silva PS, Waisberg J, Paulo CS, Colugnati F, Martins LC. Outcome of patients requiring tracheostomy in a pediatric intensive care unit. Pediatrics International: official journal of the Japan Pediatric Society 2005; 47:554-9.
- 17- Zenk J, Fyrmpas G, Zimmermann T, Koch M, Constantinidis J, Iro H. Tracheostomy in young patients: indications and long-term outcome. European Archives of Oto-rhino-laryngology 2009; 266:705-11.
- 18- Primuharsa Putra SH, Wong CY, Hazim MY, Goh BS. Paediatric tracheostomy in hospital university kebangsaan Malaysia - a changing trend. The Medical Journal of Malaysia 2006; 61:209-13.
- 19- Karapınar B, Arslan MT, Ozcan C. Pediatric bedside tracheostomy in the pediatric intensive care unit: six-year experience. The Turkish Journal of Pediatrics 2008; 50:366-72.
- 20- Serra A, Cocuzza S, Longo MR, Grillo C, Bonfiglio M, Pavone P. Tracheostomy in childhood: new causes for an old strategy. European Review for Medical and Pharmacological Sciences 2012; 16:1719-22.
- 21- Carron JD, Derkay CS, Strope GL, Nosonchuk JE, Darrow DH. Pediatric tracheotomies: changing indications and outcomes. Laryngoscope 2000; 110:1099-1104.
- 22- Graf JM, Montagnino BA, Hueckel R, McPherson ML. Pediatric tracheostomies: a recent experience from one academic center. Pediatric Critical Care Medicine 2008; 9:96-100.
- 23- Roberts J, Powell J, Begbie J, Siou G, McLarnon C, Welch A, McKean M, Thomas M, Ebdon AM, Moss S, Agbeko RS, Smith JH, Brodlie M, O’Brien C, Powell s. Pediatric tracheostomy: A large single-center experience. Laryngoscope 2020; 130(5):E375-E380.
- 24- Papuzinski C, Durante M, Tobar C, Martinez F, Labarca E. Predicting the need of tracheostomy amongst patients admitted to an intensive care unit: A multivariate model. American Journal of Otolaryngology 2013; 34:517-22.
- 25- MacIntyre NR, Epstein SK, Carson S, Scheinhorn D, Christopher K, Muldoon S, National association for medical direction of respiratory care. Management of patients requiring prolonged mechanical ventilation: Report of a NAMDRC consensus Conference. Chest 2005; 128:3937-54.
- 26- Holloway AJ, Spaeder MC, Basu S. Association of timing of tracheostomy on clinical outcomes in PICU patients. Pediatric Critical Care Medicine 2015; 16:52-8.
- 27- Lee W, Koltai P, Harrison AM, Appachi E, Bourdakos D, Davis S, Weise K, McHugh M, Connor J. Indications for tracheotomy in the pediatric intensive care unit population: A pilot study. Archives of Otolaryngology--Head & Neck Surgery 2002; 128:1249-52.
- 28- Tekerek NU, Akyıldız BN. Üçüncü basamak bir merkezde çocuk yoğun bakım hastalarının prognozunun belirlenmesi. Turkish Journal of Pediatric Disease 2017; 4:221-5.
- 29- Smith MM, Benscoter D, Hart CK. Pediatric tracheostomy care updates. Current Opinion in Otolaryngology & Head and Neck Surgery 2020; 28(6):425-9.
Çocuk Yoğun Bakım Hastalarının Trakeostomi Uygulama Etyolojileri ve Klinik Değerlendirilmesi: Retrospektif Çalışma
Öz
Amaç: Günümüzde çocuk yoğun bakım ünitesinde trakeostomi uygulanması ve trakeostomi ile mekanik ventilatör desteğinde evde ve/veya yoğun bakımda izlenen hastalar giderek artmaktadır. Çalışmamızda çocuk yoğun bakım hastalarında trakeostomi açılma etyolojileri ile demografik verileri, klinik izlem süreci, komplikasyonları, evde bakım/hastanede palyatif bakım, mortalite ve dekanülasyon durumu incelenmesi amaçlanmıştır.
Yöntem: Ocak2021-Aralık2021 arasında 1ay-18yaş arası tüm çocuk yoğun bakımdaki trakeostomili hastalar çalışmaya dahil edildi. Verileri retrospektif olarak elektronik ve/veya arşiv dosyalarından elde edilmiştir. Demografik verileri, yatış nedeni ve süresi, yaş ve cinsiyet durumu, Pediatrik Risk of Mortality III Skoru, Glasgow Koma Skoru, kabul yeri, trakeostomi endikasyonu ve komplikasyonu, ekstübasyon denenme sayısı, kanül tipi ve boyutu, mekanik ventilasyondan ayrılması, klinik ve laboratuvar patolojileri, aile bakımı/palyatif bakım, mortalite ve morbiditesi detaylı olarak incelenmiştir.
Bulgular: Trakeostomi açılan 34(%6.48) hastanın yaş ortalamaları 56,50±66,94 ay, yatış süresi 232.15±195.86 gün olup maalesef 17(%50) tanesi hayatını kaybetmiştir. Yaşayanların 11’i(%32.35) taburcu edilmiştir. PRISM III skoru ortalama 18.82±8.60 ve ilk GKS <8 23(%67.65) ve GKS >8 11(%32.35) taneydi. İlk yatış tanıları en sık pnömoni 25(%73.53) olup 30(%88.24) hastanın ek hastalığı mevcuttu. Başarısız extübasyon ortalama 1,41±0,98 idi. 31(%91.18) hastada herhangi komplikasyon görülmedi. En sık trakeostomi endikasyonu nörolojik sorunlar 17(%50) nedeniyle gelişen uzamış entübasyon süresi olup sadece 14(%41.18) hasta aile eğitimi alarak evinde izlenmeye devam edilmiştir.
Sonuç: Çocukluk çağında trakeostomi uygulaması güvenli ve gereklidir. Prognozunu asıl belirleyen trakeostomi endikasyonu ve/veya ek hastalıklarının bulunmasıdır. Trakeostomi uygulanan hastalarda, ailelerinin de iş birliği ile hastane yatış süreleri azaltılabilir. Hastaların hayat kaliteleri arttırılabilir.
Anahtar Kelimeler
Kaynakça
- 1- Can FK, Anıl AB, Anıl M, Gümüşsoy M, Çitlenbik H, Kandoğan T, Zengin N. Türkiye’de üçüncü basamak bir çocuk yoğun bakımda trakeostomi uygulanan çocukların sonuçları. Türk Pediatri Arşivi 2018; 53(3):177-84.
- 2- Trachsel D, Hammer J. Indications for tracheostomy in children. Paediatric Respiratory Review 2006; 7(3):162-8.
- 3- Midwinter KI, Carrie S, Bull PD. Paediatric tracheostomy: Sheffield experience 1979-1999. The Journal of Laryngology and Otology 2002; 116(7):532-35. 4- Acar B, Acar M, Yıldız E, Karaşen RM. Çocuk Trakeostomi: Endikasyonlar, Komplikasyonlar ve 20 Olgunun İncelenmesi. Turgut Özal Tıp Merkezi Dergisi 2014; 211:41-3.
- 5- Kaygusuz U, Kayalı Dinç AS, Dinç T. Pediatrik Trakeotomi Deneyimimiz: Ameliyathanede mi, Yoğun Bakımda mı Açalım? Güncel Pediatri 2014; 2: 59-62.
- 6- Wetmore RF, Handler SD, Potsic WP. Paediatric tracheostomy:experience during the past decade. Annals of Otology, Rhinology and Laryngology 1982; 91:628-32.
- 7- Carron JD, Derkay CS, Strope GL, Nosonchuk JE, Darrow DH, Pediatric tracheostomies: changing indications and outcomes. Laryngoscope 2000; 110: 1099-1104.
- 8- 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. Archives in Diseases in Childhood 2010; 95:703-10.
- 9- Kremer B, Botos-Kremer AI, Eckel HE, Schlöndorff G. Indications, complications, and surgical techniques for pediatric tracheostomies–an update. Journal of Pediatric Surgery 2002; 37:1556-62.
- 10- Wood D, McShane P, Davis P. Tracheostomy in children admitted to paediatric intensive care. Archives in Diseases in Childhood 2012; 97: 866–900.
- 11- Ertugrul I, Kesici S, Bayrakci B, Unal OF. Tracheostomy in pediatric intensive care unit: When and Where? Iranian Journal of Pediatrics 2016; 26:e2283.
- 12- Mahafza T, Batarseh S, Bsoul N, Massad E, Qudaisat I, Al-Layla AE. Early vs. late tracheostomy for the ICU patients: Experience in a referral hospital. Saudi Journal of Anaesthesia 2012; 6(2):152-4.
- 13- Dursun A, Tekerek NÜ, Akyıldız B. Çocuk yoğun bakım ünitesinde trakeostomi açılan olguların değerlendirilmesi: Mekanik ventilatörden ayrılma ve Dekanülasyon Sonuçlarımız. Türkiye Çocuk Hastalıkları Dergisi 2018; 12(2):74-8.
- 14- Fidancı K, Parlak A. Çocuklarda Tam Kan İncelemesi. In: Yeşilkaya Ş, Özenç S, Babacan O, Yeşilkaya E, editors. Aile Hekimliğinde Sağlam Çocuk İzlemi. Ankara, 2013: 88-91.
- 15- Dursun O, Ozel D. Early and long-term outcome after tracheostomy in children. Pediatrics International: official journal of the Japan Pediatric Society 2011; 53: 202–6.
- 16- Da Silva PS, Waisberg J, Paulo CS, Colugnati F, Martins LC. Outcome of patients requiring tracheostomy in a pediatric intensive care unit. Pediatrics International: official journal of the Japan Pediatric Society 2005; 47:554-9.
- 17- Zenk J, Fyrmpas G, Zimmermann T, Koch M, Constantinidis J, Iro H. Tracheostomy in young patients: indications and long-term outcome. European Archives of Oto-rhino-laryngology 2009; 266:705-11.
- 18- Primuharsa Putra SH, Wong CY, Hazim MY, Goh BS. Paediatric tracheostomy in hospital university kebangsaan Malaysia - a changing trend. The Medical Journal of Malaysia 2006; 61:209-13.
- 19- Karapınar B, Arslan MT, Ozcan C. Pediatric bedside tracheostomy in the pediatric intensive care unit: six-year experience. The Turkish Journal of Pediatrics 2008; 50:366-72.
- 20- Serra A, Cocuzza S, Longo MR, Grillo C, Bonfiglio M, Pavone P. Tracheostomy in childhood: new causes for an old strategy. European Review for Medical and Pharmacological Sciences 2012; 16:1719-22.
- 21- Carron JD, Derkay CS, Strope GL, Nosonchuk JE, Darrow DH. Pediatric tracheotomies: changing indications and outcomes. Laryngoscope 2000; 110:1099-1104.
- 22- Graf JM, Montagnino BA, Hueckel R, McPherson ML. Pediatric tracheostomies: a recent experience from one academic center. Pediatric Critical Care Medicine 2008; 9:96-100.
- 23- Roberts J, Powell J, Begbie J, Siou G, McLarnon C, Welch A, McKean M, Thomas M, Ebdon AM, Moss S, Agbeko RS, Smith JH, Brodlie M, O’Brien C, Powell s. Pediatric tracheostomy: A large single-center experience. Laryngoscope 2020; 130(5):E375-E380.
- 24- Papuzinski C, Durante M, Tobar C, Martinez F, Labarca E. Predicting the need of tracheostomy amongst patients admitted to an intensive care unit: A multivariate model. American Journal of Otolaryngology 2013; 34:517-22.
- 25- MacIntyre NR, Epstein SK, Carson S, Scheinhorn D, Christopher K, Muldoon S, National association for medical direction of respiratory care. Management of patients requiring prolonged mechanical ventilation: Report of a NAMDRC consensus Conference. Chest 2005; 128:3937-54.
- 26- Holloway AJ, Spaeder MC, Basu S. Association of timing of tracheostomy on clinical outcomes in PICU patients. Pediatric Critical Care Medicine 2015; 16:52-8.
- 27- Lee W, Koltai P, Harrison AM, Appachi E, Bourdakos D, Davis S, Weise K, McHugh M, Connor J. Indications for tracheotomy in the pediatric intensive care unit population: A pilot study. Archives of Otolaryngology--Head & Neck Surgery 2002; 128:1249-52.
- 28- Tekerek NU, Akyıldız BN. Üçüncü basamak bir merkezde çocuk yoğun bakım hastalarının prognozunun belirlenmesi. Turkish Journal of Pediatric Disease 2017; 4:221-5.
- 29- Smith MM, Benscoter D, Hart CK. Pediatric tracheostomy care updates. Current Opinion in Otolaryngology & Head and Neck Surgery 2020; 28(6):425-9.
Ayrıntılar
| Birincil Dil | Türkçe |
|---|---|
| Konular | Klinik Tıp Bilimleri |
| Bölüm | Araştırma Makalesi |
| Yazarlar | |
| Erken Görünüm Tarihi | 10 Mayıs 2024 |
| Yayımlanma Tarihi | 1 Mayıs 2024 |
| Gönderilme Tarihi | 8 Aralık 2022 |
| Yayımlandığı Sayı | Yıl 2024 Cilt: 10 Sayı: 2 |
