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ORIGINAL RESEARCH

Pediatric Tracheotomy: A Single Center Pediatric Cardiac Intensive Care Unit Experience
Pediatrik Trakeotomi: Tek Merkezli Pediatrik Kardiyoloji Yoğun Bakım Deneyimimiz
Received Date : 15 Aug 2019
Accepted Date : 26 Aug 2019
Doi: 10.24179/kbbbbc.2019-71016 - Makale Dili: TR
KBB ve BBC Dergisi 2019;27(2):63-9
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: The aim of this study was to provide a retrospective analysis of pediatric tracheotomies performed in our hospital and to compare the findings with the literature and to identify possible similar and different aspects. Material and Methods: Pediatric tracheotomies performed at Başkent University Konya Training and Research Center between January 2015 and May 2019 were reviewed retrospectively. All patients under 16 years of age who underwent tracheotomy were identified from the hospital information system. The indications for tracheotomy, duration of intubation, age and weight when tracheotomy was performed, complications, mortality and decannulation status were examined. Results: A total of 35 patients underwent tracheotomy. Standard tracheotomy procedure was performed for all patients. Fifteen (42.9%) of the patients were male and 20 (57.1%) were female. Sixty percent of the patients (21 patients) had previous cardiac surgery. The mean age was 13 months (1 month-90 months). 77% (27 patients) of the patients were under one year of age. This rate was 80.9% in the group undergoing cardiac surgery. The mean weight of the patients was 6.192 gram during the procedure. The most common indication for tracheotomy was neurological reasons (14 patients, 40%) followed by prolonged intubation (11 patients, 31.4%) and upper airway obstruction (10 patients, 28.6%), respectively. Major complications were observed in 2 (5.7%) patients, while mortality due to tracheotomy occurred in 1 (2.8%) patient. Conclusion: Especially in recent years due to improvements in pediatric intensive care services pediatric tracheotomy become frequently performed surgical procedure, In our patient group most common indication for tracheotomy was neurological reasons. Prolonged intubation and upper airway obstruction were the indications in patients undergoing cardiac surgery. While the major complication and mortality rates in our patients were within acceptable limits, decanulation rates were found to be low.
ÖZET
Amaç: Bu çalışmada, hastanemizde gerçekleştirilmiş olan pediatrik trakeotomilerin retrospektif analizi sağlanarak elde edilen bulguların literatürle karşılaştırılması ve olası benzer ve farklı yönlerin ortaya konması hedeflenmiştir. Gereç ve Yöntemler: Başkent Üniversitesi Konya Eğitim ve Araştırma Merkezi’nde Ocak 2015-Mayıs 2019 tarihleri arasında gerçekleştirilmiş olan pediatrik trakeotomiler retrospektif olarak incelenmiştir. Hastane bilgi sisteminden, trakeotomi açılan 16 yaş altı tüm hastalar tespit edilmiş; hastaların trakeotomi açılma endikasyonları, entübasyon süreleri, trakeotominin açıldığı dönemdeki yaş ve kiloları, karşılaşılan komplikasyonlar, mortalite ve dekanülasyon durumları incelenmiştir. Bulgular: Toplam 35 hastaya trakeotomi açıldığı tespit edildi. Tüm hastalara standart trakeotomi prosedürü uygulandı. Hastaların 15 (%42,9)’i erkek, 20 (%57,1)’si ise kız idi. Hastaların %60 (n=21)’ında geçirilmiş kardiyak cerrahi söz konusuydu. Ortalama yaş 13 ay (1-90 ay) idi. Hastaların %77 (n=27)’si bir yaş altındaydı. Bu oran, kardiyak cerrahi geçiren grupta %80,9 idi. İşlem sırasında hastaların ortalama kiloları 6,192 gram idi. En sık trakeotomi endikasyonu nörolojik nedenlere bağlı olup (14 hasta; %40), bunu sırasıyla uzamış entübasyon (11 hasta; %31,4) ve üst hava yolu obstrüksiyonu (10 hasta; %28,6) takip etmekteydi. İki (%5,7) hastada majör komplikasyon izlenirken, trakeotomiye bağlı mortalite 1 (%2,8) hastada ortaya çıktı. Sonuç: Pediatrik trakeotomi işlemi, özellikle son yıllarda pediatrik yoğun bakım hizmetlerindeki gelişmelerle daha sık ihtiyaç duyulan özellikli bir cerrahidir. Bu çalışmada, hastalarımızda en sık trakeotomi endikasyonunun nörolojik nedenlere bağlı olduğu, kardiyak cerrahi geçiren hastalarda ise uzamış entübasyon ve üst havayolu tıkanıklığının etiyolojide yer aldığı tespit edilmiştir. Majör komplikasyon ve mortalite oranlarımız kabul edilebilir sınırlarda iken dekanülasyon oranlarımızın düşük olduğu görülmüştür.
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