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
Selin ÜSTÜN BEZGİNa, Taliye ÇAKABAYa, Murat KOÇYİĞİTa, Havva Duru İPEKa,
Safiye GİRAN ÖRTEKİNa, Hakan GEMİCİb
aİstanbul Kanuni Sultan Süleyman Training and Research Hospital, Department of Otorhinolaryngology, İstanbul, TURKEY
bİstanbul Kanuni Sultan Süleyman Training and Research Hospital, Department of Pediatrics, İstanbul, TURKEY
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.
Keywords: Pediatric; tracheotomy; heart diseases; nervous system diseases; cumulative trauma disorder
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.
Anahtar Kelimeler: Pediatrik; trakeotomi; kalp hastalıkları; sinir sistemi hastalıkları; kümülatif travma hastalıkları
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