Tuba KOÇKAR, Füsun ÜNAL, Şifa ŞAHİN, Gizem ONDALIKOĞLU, Sedat ÖKTEM

Trakeostomili Çocuklarda Takip Sonuçlarımız

Amaç: Çocuklarda trakeostomi; en sık uzamış entübasyon, santral hipoventilasyon, nöromuskuler hastalıklar, ileri derecede laringomalazi ya da trakeomalazi varlığı gibi birçok farklı endikasyonla yapılmaktadır. Gereçler ve Yöntem: Kliniğimizden takipli trakeostomi ile izlenen hastaların demografik özellikleri ve takip süreçlerinin değerlendirilmesi amaçlanmıştır. 48 hastanın verileri geriye dönük olarak incelenmiştir. Bulgular: Toplam hasta sayısı 48 olup, bunlardan 19’u kız, 29’u erkek idi. Hastaların yaş ortalaması 2,5±1,8 yaş idi. Trakeostomi açılma yaşı median değeri 6 ay (25P: 3 ay, 75P:15 ay) idi. Trakeostomi endikasyonları sıklık sırasıyla uzamış entübasyon, nöromuskuler hastalıklar, üst havayolu anomalileri ve travma idi. Uzamış entübasyon ihtiyacı olan hastalarda altta yatan en sık nedenler bronkopulmoner displazi ve konjenital kalp hastalığı idi. Hastaların tümü trakeostomi öncesi mekanik ventilasyon (MV) desteği almış, 32 hastanın izlemde (% 66,7) solunum desteği ihtiyacı kalmamıştı. Yirmi bir hasta (% 43,8) hala trakeostomize olarak izlenirken 19 hastamız (% 39,6) dekanüle edilmişti. Trakeostomize olarak izlenen 21 hastamızdan 14’ü, dekanüle edilen 19 hastadan 2’si halen evde solunum desteği almaktaydı. İki hasta (% 4,2) takipten çıkarken, 6 hasta ise (% 12,4) kaybedilmişti. Sonuç: Uzamış entübasyon ihtiyacı olan hastaların trakeostomi ile izlemi, yoğun bakım yatış sürelerinin azalmasına, hastaların evde takibine, daha normal günlük yaşantı ve daha düşük hasta bakım maliyetine olanak sağlamaktadır. Ancak mümkün olan en kısa sürede bu hastaların trakeostomileri kapatılmalıdır.

Follow-up Results in children with Tracheostomy

Objective: Tracheostomy is applied for many different indications in children. The most comman indications are prolonged intubation, central hypoventilation, neuromuscular disorders, severe laryngomalacia or tracheomalacia. Material and Methods: Our aim was to evaluate the demographic features and follow-up processes of patients with tracheostomy at our clinic. The data of 48 patients were retrospectively reviewed. Results: Forty eight patients were enrolled, 19 of them were girls, 29 of them were boys. The mean age of the patients was 2.5 ± 1.8 years. The median age of tracheostomy operations was 6 months (25P: 3 months, 75P: 15 months). Tracheostomy indications were prolonged intubation, neuromuscular disorders, upper airway anomalies and trauma, respectively. The most common underlying causes in patients with prolonged intubation were bronchopulmonary dysplasia and congenital heart disease. All patients received mechanical ventilation (MV) support before prosecure, and for 32 patients (66.7%) there were no need for respiratory support at follow up. Twenty-one patients (43.8%) were still tracheostomized and 19 patients (39.6%) were decannulated. Fourteen of twentyone patients who were tracheostomized and 2 of 19 patients who were decannulated were still receiving respiratory support at home during the study period. Two patients (4.2%) were lost during follow up and 6 patients (12.4%) died. Conclusion: Tracheostomy is a voluable prosecure for patients who need prolonged intubation by shortening intensive care stay, allowing the follow up at home in normal life, and low cost. However, successful decanulation as soon as possible, is the final goal of management.

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