Çocuk Yoğun Bakım Ünitesinde Trakeostomi Uygulamaları, Tek Merkez Deneyimi

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.