Pediatric Intensive Care Unit Tracheostomy Experiences in Ondokuz Mayıs University Faculty of Medicine

Authors : Cem METE, Gülfer AKÇA, Ünal AKÇA, Nazik  AŞILIOĞLU

Pages : 403-408

View : 46 | Download : 12

Publication Date : 2022-03-18

Article Type : Research Paper

Abstract :INTRODUCTION: Tracheostomy is a clinical practice that has been increasing in frequency recently in patients undergoing respiratory support insert ignore into journalissuearticles values(mechanical ventilation); with endotracheal intubation in the Pediatric Intensive Care Unit insert ignore into journalissuearticles values(PICU);. In this study, patients who underwent tracheostomy with conventional surgical method while being followed up on mechanical ventilator with endotracheal intubation between 2006 and 2013 in our unit were evaluated retrospectively. In our study, ıt was aimed to share the positive changes in the clinical-mechanical ventilation parameters in the follow-up of the patients in the PICU after the tracheostomy procedure with the literature. METHODS: Study data were primarily obtained from medical records in the Hospital Information Management System insert ignore into journalissuearticles values(HIMS);. After examining the medical records in detail in terms of the data below the `Child Patient Evaluation Form with Tracheostomy` was created. Medical records; some demographic data insert ignore into journalissuearticles values(eg, age, gender and chronic disease);, diagnosis of PICU admission, indications for mechanical ventilation and tracheostomy, mechanical ventilation before/after the procedure insert ignore into journalissuearticles values(eg; PIP, PEEP, TV); parameters, total length of stay in the PICU before and after the procedure, complications of tracheostomy, decannulation time and results, and survival and death rates in discharged patients, etc. contained. Medical records for the post-discharge period were created by making phone calls with the families. IBM SPSS 21 insert ignore into journalissuearticles values(Statistical Package for Social Sciences); program was used for statistical analysis. The conformity of the data to the normal distribution was evaluated with the Kolmogorov-Smirrnov test. The sample sizes required for T-test, one-way ANOVA and Chi-square tests for independent groups with different effect sizes, different statistical power levels and 5% statistical significance were calculated using the GPower 3.1 program. Clinical studies ethics committee approval was received on 31.05.2013 with the number B.30.2.ODM.0.20.08/516. RESULTS: Tracheostomy was performed in 104 of 2406 patients followed in the PICU between January 2006 and April 2013. An annual average of 14.2 insert ignore into journalissuearticles values(4.3%); patients underwent the procedure. In our study the median age of tracheostomy was 13.5 insert ignore into journalissuearticles values(2-215); months; 44.2% of the patients were under the age of one at the time of the procedure and 62.0% were male. Neurological / neuromuscular diseases insert ignore into journalissuearticles values(45.0%); ranked first among primary health problems. In this study, the need for prolonged mechanical ventilation insert ignore into journalissuearticles values(67.0%); was the most common tracheostomy indication while the other frequent indication was upper airway obstruction insert ignore into journalissuearticles values(21.0%);. Congenital airway anomalies insert ignore into journalissuearticles values(Pierre Robin sequence developmental malformations, retrognatti, etc.); were present in 57.2% of the patients who underwent tracheotomy due to upper airway obstruction. Due to the need for prolonged mechanical ventilation the decision to perform a tracheostomy was made after 4 weeks of hospitalization in the PICU in 52 insert ignore into journalissuearticles values(77.6%); of 67 patients. In this study clinical changes after the procedure were compared with those before in patients who had long-term mechanical ventilation with endotracheal intubation. In this patient group the Peak Inspiratory Pressure insert ignore into journalissuearticles values(PIP); requirement on the mechanical ventilator also decreased statistically significantly and the Tidal Volume insert ignore into journalissuearticles values(TV); increased significantly insert ignore into journalissuearticles values(both p 2-4 weeks); due to progressive primary disease. Despite the results of clinical studies in the literature that support the application of tracheostomy in the early period in patients given endotracheal intubation insert ignore into journalissuearticles values(mechanical ventilation); and respiratory support in the PICU as shown in some systematic analyzes patient-centered insert ignore into journalissuearticles values(=individual); decision making is more appropriate. In patients with insufficient pulmonary ventilation capacity tracheostomy may facilitate the transition to spontaneous breathing by improving respiratory mechanics insert ignore into journalissuearticles values(for example, by reducing workload);. Tracheostomy is also very important in terms of providing general psychosocial-physical well being within appropriate medical indications as it shortens the length of stay in the hospital/PICU and provides medical care in a suitable home environment outside the hospital.
Keywords : Pediatric İntensive Care Unit, Prolonged Mechanical Ventilation, Tracheostomy, Decanulation

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