Abstract:

The purpose:

This study aims to evaluate the patient’s characteristics, indications, additional interventions and results related to surgical tracheotomy in children managed as multidisciplinary in the child and newborn intensive care unit (PICU, NICU).

The Method: We conducted a backward study in which 106 pediatric tracheotomy procedures (TP) were assessed in our hospital, the third stage delivery center. The inclusion criteria were elective TPs made by children's surgeons between 0-17 years of age and January 2018 and January 2021. Patients with tracheostomy or who are applied to emergency TP have been dismissed. The medical records and tracking findings of children with TP were reviewed backward. Characteristics of children, trakeotomy indications and methods, additional interventions, complications and results were recorded.

The findings: The average age of 3.59 (10 days-17 years), sixteen four (45 girls; 39 boys) children, met the inclusion criteria. The vast majority of trakeotomy indications (88%) were extended mechanical ventilation (n:74) while in ten patients there was airway obstruction (12%). All operations were performed under general anesthesia. The average stay time (LOS) is 35.06 (13-74 days) day. 31 (37%) anti-reflus and gastrostomy process were applied as an additional initiative in trakeotomic cases. In nine patients, early complications (%11) were recorded. These were patients developing bleeding (n:3), accidental dekanulation (n:4) and pnömotoraks (n:2). Late complications (%4) included granulation tissue formation (n:1) and tracheotomy density (n:2). Fourteen patients (16.6%) were lost due to underlying diseases within an average of 33 days (2-76 days) after the tracheotomy process. So far, four patients have been dekanalized.

The result In our series, the number of children under one year was greater and long-term ventilation addiction was responsible for the maximum number of indications for tracheostomy, followed by the causes of airway obstruction. Pediatric tracheotomy is a safe and effective process with a noticeable improvement in airway symptoms in all age groups, a noticeable reduction in LOS and a low rate of complications.

Keywords:

Abstract:

Objectives: To assess the patient characteristics, indications, additional interventions, and outcomes associated with surgical tracheostomy in children managed multidisciplinary for pediatric and neonatal intensive care unit (PICU, NICU) following for 3 years.

Methods: We performed a retrospective, descriptive study within 106 pediatric tracheostomy procedures (TP) in a tertiary pediatric referral center. Inclusion criteria were age range 0-17 years and elective TPs performed by pediatric surgeons between January 2018 and January 2021. The patients existing tracheostomy or undergoing emergency TPs were excluded. The medical records and follow-up findings of pediatric patients with TP were retrospectively analyzed. The children's characteristics, indications and methods of tracheostomy, additional interventions, complications, and outcomes were recorded.

Results: Eighty-four children (45 female, 39 male) met inclusion criteria with a median age of 3.59 years (10 days–17 years). A tracheostomy was performed to address the complications arising from prolonged mechanical ventilation in 74 children (88%) or upper airway obstruction in 10 children (12%). All interventions were performed under general anesthesia in the operating theatre. The mean length of stay (LOS) was 35.06 (13–74 days) days. There were 31 (37%) anti-reflux and gastrostomy procedures performed as an additional intervention in cases with a tracheostomy. Early complications (11%) were noted in nine patients and included hemorrhage (n:3), accidental decannulation (n:4), and pneumothorax (n:2). Delayed complications (4%) included granulation tissue (n:1) and stenosis of tracheotomy (n:2). Fifteen patients  (18%) died within an average of 33 days (2–76 days) after the tracheostomy procedure due to underlying diseases. Four patients were decannulated until now.

Conclusion: The under 1-year old patients predominated our series, and prolonged ventilation dependency accounted for the largest number of indications for tracheostomy, followed by airway obstruction causes.  The pediatric tracheostomy is a safe and effective procedure that has a significant improvement in airway symptoms, a marked reduction in the LOS, and a low complication rate in all age groups.

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