Hale Çitlenbik, Murat Gümüşsoy, Neslihan Zengin, Tolga Kandoğan, Murat Anıl, Fulya Kamit Can, Ayşe Berna Anıl

Türkiye’de üçüncü basamak bir çocuk yoğun bakımda trakeostomi uygulanan çocukların sonuçları

Amaç: Amacımız üçüncü basamak Çocuk Yoğun Bakım Birimi’mizdetrakeostomi sonuçlarını etkileyen klinik özellikleri tanımlamaktır.Gereç ve Yöntemler: Türkiye’de çocuk yoğun bakım birimimizde2008-2014 yılları arasında trakeostomi uygulanmış çocuk hastalarıntıbbi kayıtları geriye dönük olarak incelendi.Bulgular: Toplamda 63 çocuk hasta çalışmaya alındı. Hastaların ortanca yaşı 11 ay (1 ay-195 ay) ve 25 hasta (%39,7) kız idi. Altı yıllıkçalışma döneminde trakeostomi oranı %8,5 ve dekanülasyon oranı(n=8) %12,6 bulundu. Kırk dokuz (%77,7) hasta eve taburcu edildi.Trakeostomi uygulama endikasyonları üst hava yolu tıkanıklığı (n=9)ve uzamış mekanik ventilasyon idi (n=54). Trakeostomi öncesi entübasyon süresi ortanca 32 gün (1-122 gün) ve trakeostomi sonrasıçocuk yoğun bakım yatış süresi ortanca 37 gündü. Toplamda 21 hasta(% 52,5) mekanik ventilatörden ayrıldı. Üst hava yolu tıkanıklığı nedeniyle trakeostomi uygulanan hastalarda mekanik ventilatörden ayrılma oranı, uzamış mekanik ventilasyon nedeniyle trakeostomi uygulanan hastalardan belirgin yüksekti (p=0,021). Komplikasyon oranıevde %11,1 çocuk yoğun bakımda ise %25,3 saptandı.Çıkarımlar: Trakeostomi uygulaması, çocuk hastaların sonuçlarını iyileştiren güvenli bir yöntem olarak gözükmektedir. Trakeostomi uygulanan çocuklarda seyri etkileyen en önemli etken ise trakeostomiendikasyonu olarak bulunmuştur. Üst hava yolu tıkanıklığı nedeniyletrakeostomi uygulanan hastalarda sonuçların daha iyi olduğu görülmüştür. Çocuk hastalarda uzamış mekanik ventilasyonda trakeostomi uygulaması mekanik ventilatör desteğinin azaltılmasını, mekanikventilatörden ayrılmayı ve en nihayetinde eve taburculuğu kolaylaştırmaktadır.

The outcomes of children with tracheostomy in a tertiary care pediatric intensive care unit in Turkey

Aim: We aimed to describe which clinical characteristics were associated with the outcome of tracheostomy in our tertiary care pediatric intensive care unit. Material and Methods: This was a retrospective review of medical records of pediatric patients who underwent tracheostomy in our Pediatric Intensive Care unit from 2008 to 2014 in Turkey. Results: Sixty-three patients were included the study. The median age of patients was 11 (range, 1-195) months. Twenty-five (39.7%) patients were female. The tracheostomy rate was 8.5% over a six-year period. Forty-nine (77.7%) patients were able to be discharged and sent home. The decannulation rate was 12.6% (n=8). The indications for tracheostomy were upper airway obstruction (n=9) and prolonged mechanical ventilation (n=54). The median intubation period before tracheostomy was 32 (range, 1-122) days and the median duration of pediatric intensive care unit stay after tracheostomy was 37 days. A total of 21 (52.5%) patients were weaned off mechanical ventilation. The rate of successful weaning from mechanical ventilation was higher in patients with upper airway obstruction than in those in the prolonged mechanical ventilation group (p=0.021). The complication rate was 25.3% in the pediatric intensive care unit and 11.1% at home. Conclusions: Tracheostomy seems safe and improves pediatric patients’ outcomes. The most important factor that affects the prognosis of children who underwent tracheostomy is the indication for tracheostomy. The outcomes are always better if the tracheostomy has been performed because of upper airway obstruction. Performing tracheostomy helps weaning from and off ventilator support and finally the discharge of patients with prolonged mechanical ventilation from the pediatric intensive care unit setting.

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