ISSN: 1300 - 6525 E-ISSN: 2149 - 0880
kulak burun boğaz
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ORIGINAL RESEARCH

Pediatric Tracheotomy: Indications and Outcomes
Pediatrik Trakeotomi: Endikasyonlar ve Sonuçlarımız
Received Date : 07 Feb 2020
Accepted Date : 15 Apr 2020
Available Online : 01 May 2020
Doi: 10.24179/kbbbbc.2020-74159 - Makale Dili: EN
KBB ve BBC Dergisi. 2020;28(2):124-30
Copyright © 2020 by Turkey Association of Society of Ear Nose Throat and Head Neck Surgery. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/)
ABSTRACT
Objective: To investigate the indications and outcomes of our pediatric tracheotomy patients. Material and Methods: In this retropective study, we reviewed 47 pediatric patients who were performed tracheotomy by Otorinolaryngology Department between 2013 and 2018. Age, gender, indications of tracheotomy, presence of syndromic condition, duration of intubation, decannulation outcomes and mortality rates were collected. Results: The present study included 47 pediatric cases that underwent a tracheotomy, of which 48.9% (n=23) were female and 51.1% (n=24) were male. The mean age of the patients at the time of the tracheotomy was 4.20±5.94 years and the age range was 29 days to 17.99 years. The mean intubation time was 39.23±32.09 days (range 6–154 days). The indication for tracheotomy was neurological deficit in 46.8% (n=22), cardiopulmonary disease in 29.8% (n=14), trauma in 17.0% (n=8), craniofacial anomaly in 4.3% (n=2) and airway obstruction in 2.1% (n=1) of the patients. Age was significantly higher in the trauma patients than in the patients who underwent a tracheotomy with indications of neurological deficit and cardiopulmonary disease (p=0.049; p=0.001). The intubation time was significantly higher in patients with cardiopulmonary disease than in patients with neurological deficit and trauma (p=0.048; p=0.001). A syndrome was detected in 19.1 (n=9) of the patients. Of the patients, 46.8% (n=22) were survivors, 42.6% (n=20) were non-survivors, and 10.6% (n=5) could not be reached. Death due to tracheotomy was not observed in any patient. Decannulation rate was 40.9% (n=9) in survivors. Conclusion: Indications and results may vary in studies examining pediatric tracheotomy patients. For this reason, it is important to follow up-to-date data on this issue and to reveal the differences. In this study, children with neurological deficits and cardiopulmonary disease constitute the majority of pediatric cases undergoing a tracheotomy, with trauma ranking third among the etiologies. A limited number of tracheotomies were performed with indications of craniofacial anomalies and airway obstructions. Intubation time was high in the group with cardiopulmonary disease and tracheotomy age was high in patients with trauma.
ÖZET
Amaç: Bu çalışmanın amacı pediatrik trakeotomi hastalarımızın endikasyon ve sonuçlarını araştırmaktır. Gereç ve Yöntemler: Bu retrospektif çalışmada 2013-2018 yılları arasında Kulak Burun Boğaz Bölümü tarafından trakeotomi uygulanan 47 pediatrik hasta gözden geçirildi. Hastaların yaş, cinsiyet, trakeotomi endikasyonları, sendromik durum varlığı, entübasyon süresi, dekanülasyon sonuçları ve mortalite oranları incelendi. Bulgular: Bu çalışmaya trakeotomi uygulanan 47 çocuk olgu dahil edildi; bunların %48,9’u (n=23) kız ve%51,1’i (n=24) erkekti. Trakeotomi sırasında hastaların ortalama yaşı 4,20 ± 5,94 yıl ve yaş aralığı 29 gün ila 17,99 yıl arasındaydı. Ortalama entübasyon süresi 39,23±32,09 gün (6-154 gün) idi. Trakeotomi endikasyonları %46,8 (n=22) nörolojik defisit, %29,8 (n=14) kardiyopulmoner hastalık, %17,0 (n=8) travma, %4,3 (n=2) kraniyofasiyal anomali ve %2,1 (n=1) hava yolu obstrüksiyonu idi. Travma hastalarında yaş, nörolojik defisit ve kardiyopulmoner hastalığı olan hastalardan anlamlı olarak daha yüksekti (p=0,049; p=0,001). Entübasyon süresi kardiyopulmoner hastalığı olan hastalarda nörolojik defisit ve travması olanlara göre anlamlı derecede yüksekti (p=0,048; p=0,001). Hastaların %19,1’inde (n=9) bir sendrom saptandı. Hastaların %46,8’i (n=22) yaşamakta, %42,6’sı (n=20) ex olmuş ve %10,6’sına (n=5) ulaşılamamıştır. Trakeotomiye bağlı ölüm hiçbir hastada gözlenmemiştir. Dekanülasyon oranı sağ olanların %40,9’unda (n=9) gözlenmiştir. Sonuç: Pediatrik trakeotomi hastalarının incelendiği çalışmalarda endikasyonlar ve sonuçlar değişiklikler gösterebilmektedir. Bu nedenle bu konu ile ilgili güncel verilerin izlenmesi, farklılıkların ortaya konulması önem taşımaktadır. Bu çalışmada, pediatrik trakeotomi için en sık endikasyon nörolojik defisit, ardından ikinci sırada kardiyopulmoner hastalık ve üçüncü sırada travma gelmektedir. Kraniyofasiyal anomali ve hava yolu tıkanıklığı belirtileriyle sınırlı sayıda hastaya trakeotomi yapılmıştır. Entübasyon süresi kardiopulmoner hastalığı olan grupta, trakeotomi yaşı ise travmalı hastalarda yüksek saptanmıştır.
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