Öz
Amaç: Bu araştırmada ünitemizde trakeostomi açılmış olan hastaların endikasyonları,
erken ve uzun dönem sonuçlarının belirlenmesi amaçlanmıştır.
Gereçler ve Yöntem: Bu çalışmada Ocak 2013- Aralık 2015 arasında Zekai Tahir Burak
Kadın Sağlığı Eğitim Araştırma Hastanesi Yenidoğan Yoğunbakım kliniğinde
izlenen ve trakeostomi açılmış olan 11 hastanın geriye dönük kayıtları
incelenmiştir. Hastaların gestasyonel yaşları, doğum ağırlıkları, trakeostomi
endikasyonları, trakeostomi öncesi entübe kaldıkları gün sayısı, komplikasyonlar,
komorbiditeler, mortalite oranları, mevcut klinik durumları kaydedilmiştir.
Bulgular: Hastaların gestasyon yaşı ortanca 32 hafta (23-39), doğum
ağırlığı 1470 gr (550-3180) idi. Trakeostomi öncesi entübe kalma süresi ortanca
130 gün (1-290) idi. Trakeostomi açılma günü 73 (1-190) gün saptandı.
Trakeostomi açılma sebepleri 1 hastada konjenital laringeal anomali, dört
hastada prematürite komplikasyonları (bronkopulmoner displazi, subglottik
stenoz), üç hastada nöromüsküler güçsüzlük (asfiksi, metabolik hastalık,
myotonik distrofi), bir hastada Beckwith-Wideman sendromu, bir hastada
artrogyropozis multipleks, bir hastada Arnold-Chiari malformasyonu nedeniyle
uzamış mekanik ventilasyon idi. Trakeostomi sonrası üç (%27,2) hasta mekanik
ventilatörden ayrıldı. Bu hastalarda mekanik ventilatörden ayrılma süresi
ortanca 18,6 (4-40) gün olarak saptandı. Ortanca hospitalizasyon süresi 180
(1-350) gün olup sekiz hasta (%72,7) takip süresince primer hastalıkları
nedeniyle kaybedildi. İki (%18,1) hasta taburcu edildi. Hastaların üçüne (%27,2)
ikinci kez trakeostomi açılması gerekti, iki hastaya kazara dekanulasyon
nedeniyle, bir hastaya striktür nedeniyle revizyon yapıldı. Bir hasta
taburculuk sonrası izleminde trakeotomisi kapatıldı.
Sonuç: Günümüzde uzun süreli entübasyon ve sekelleri pediyatrik yaş
grubundaki trakeostominin en önemli endikasyonu haline gelmiştir.
Anahtar Kelimeler
Kaynakça
- Trachsel D, Hammer J. Indications for tracheostomy in children. Paediatr Respir Rev. Sep 2006. 7(3):162-8.
- Kilic D, Findikcioglu A, Akin S, Korun O, Aribogan A, Hatiboglu A. When is surgical tracheostomy indicated? Surgical "U-shaped" versus percutaneous tracheostomy. Ann Thorac Cardiovasc Surg. 2011 Feb. 17(1):29-32.
- Vakrilova L, Stancheva B, Dimitrov A, Nikolov A. The very low birth weight and very low gestational age neonates—survival, prog- nosis and perspectives [in Bulgarian]. Akush Ginekol (Sofiia). 2011;50(1):31–36
- Estournet-Mathiaud B. Tracheostomy in chronic lung disease: care and follow-up. Pediatr Pulmonol. 2001;23(suppl 23):135–136
- Keszler M. State of the art in conventional mechanical ventilation. J Perinatol. 2009;29 (4):262–275
- Baud O. Postnatal steroid treatment and brain development. Arch Dis Child Fetal Neonatal Ed. 2004;89(2):F96–F100
- Pereira KD, MacGregor AR, Mitchell RB. Complications of neonatal tracheostomy: a 5-year review. Otolaryngol Head Neck Surg. 2004;131(6):810–813
- Wheeler WB, Maguire EL, Kurachek SC, Lobas JG, Fugate JH, McNamara JJ. Chronic respiratory failure of infancy and child- hood: clinical outcomes based on un- derlying etiology. Pediatr Pulmonol. 1994;17 (1):1–5
- Zadrobilek E, Mauritz W, Spiss C, Draxler V, Sporn P. Indications for tracheotomy in long-term ventilated critically ill patients. Anasth Intensivther Notfallmed 1984; 19: 19-23.
- Kaptanoğlu M, Nadir A. Acquired tracheal lesions in childhood and its surgical management. Türkiye Klinikleri J Surg Med Sci 2006; 2: 22-26.
- Akcan AB, Dursun O. Pediatrik trakeotomi ve ev bakımı. KBB-Forum 2010; 9: 70-7.
- Swift AC, Rogers JH. The changing indications for tracheostomy in children. J Laryngol Otol 1987; 101: 1258-62.
- Rozsasi A, Kühnemann S, Gronau S, Keck T. A single-center 6-year experience with two types of pediatric tracheostomy. Int J Pediatr Otorhinolaryngol 2005; 69: 607-13.
- Carr MM, Poje CP, Kingston L, Kielma D, Heard C. Complications in pediatric tracheostomies. Laryngoscope 2001; 111: 1925-8.
- Koltai JP. Starplasty: a new technique of pediatric tracheotomy. Arch Otolaryngol Head Neck Surg 1998; 124: 1105-11.
- Fry TL, Jones RO, Fischer ND, Pillsbury HC. Comparisons of tracheostomy incisions in a pediatric model. Ann Otol Rhinol Laryngol 1985; 94: 450-3.
- Waddell A, Appleford R, Dunning C, Papsin BC, Bailey CM. The Great Ormond Street protocol for ward decannulation of children with tracheostomy: increasing safety and decreasing cost. Int J Pediatr Otorhinolaryngol 1997; 39(2): 111-18.
- Stern Y, Cosenza M, Walner D, Cotton RT. Management of persistent tracheocutaneous fistula in the pediatric age group. Ann Otol Rhinol Laryngol 1999;108(9): 880-83.
- Fitton C. Nursıng management of a child with a tracheostomy. Pediatr Clin North Am 1994; 41(3): 513-23.
- Barnes LP. Tracheostomy care: preparing parents for discharge. MCN Am J Matern Child Nurs 1992; 17(6): 293.
Öz
Aim: In this study with reviewing the tracheostomy
cases at our institution, we aimed to determine and discuss the tracheotomy
indications and early and long term outcomes.
Materials and
Method: In this study, clinical
records of 11 tracheostomy cases at Zekai Tahir Burak Maternity and Teaching
Hospital NICU between January 2013 and December 2015 were reviewed
retrospectively. The
patients’ gestational ages, birth weights, tracheotomy indications, duration of
mechanical ventilation before tracheostomy, complications, comorbidities,
mortality rate, and actual clinical condition were recorded.
Results: Gestational ages were median
32 weeks (23-31 weeks), birth weights were 1470 gr (550-3180). Prolonged intubation period was median 130 days
(1-190). Age on
tracheotomy ranged from 1 to 190 days (median 73 days). Their diagnoses were congenital laryngeal anomaly; and prolonged
mechanical ventilation due to complications of prematurity (bronchopulmonary
dysplasia, subglottic stenosis), neuromuscular weakness (asphxia, metabolic
disorder, myotonic dystrophy), Beckwith-Wideman syndrome, artrogyropozis
multiplex, Arnold-Chiari malformation. After tracheostomy three (27.2%)
patients weaned and mechanical ventilation was discontinued. In this cases,
median duration of weaning was 18.6 days (4-40). The length of hospitalization was median 180
days (1-350) and eight infants (72.7%) were lost before they discharged. Two (%18.1)
infants were discharged. Revision was made three infants due to decanulation
and tracheal stricture. Decannulation was implemented in one patient after
discharge.
Conclusion: Long-term
intubation and its sequelae have now become one of the most important
indications for tracheostomies in the paediatric age group.
Anahtar Kelimeler
Kaynakça
- Trachsel D, Hammer J. Indications for tracheostomy in children. Paediatr Respir Rev. Sep 2006. 7(3):162-8.
- Kilic D, Findikcioglu A, Akin S, Korun O, Aribogan A, Hatiboglu A. When is surgical tracheostomy indicated? Surgical "U-shaped" versus percutaneous tracheostomy. Ann Thorac Cardiovasc Surg. 2011 Feb. 17(1):29-32.
- Vakrilova L, Stancheva B, Dimitrov A, Nikolov A. The very low birth weight and very low gestational age neonates—survival, prog- nosis and perspectives [in Bulgarian]. Akush Ginekol (Sofiia). 2011;50(1):31–36
- Estournet-Mathiaud B. Tracheostomy in chronic lung disease: care and follow-up. Pediatr Pulmonol. 2001;23(suppl 23):135–136
- Keszler M. State of the art in conventional mechanical ventilation. J Perinatol. 2009;29 (4):262–275
- Baud O. Postnatal steroid treatment and brain development. Arch Dis Child Fetal Neonatal Ed. 2004;89(2):F96–F100
- Pereira KD, MacGregor AR, Mitchell RB. Complications of neonatal tracheostomy: a 5-year review. Otolaryngol Head Neck Surg. 2004;131(6):810–813
- Wheeler WB, Maguire EL, Kurachek SC, Lobas JG, Fugate JH, McNamara JJ. Chronic respiratory failure of infancy and child- hood: clinical outcomes based on un- derlying etiology. Pediatr Pulmonol. 1994;17 (1):1–5
- Zadrobilek E, Mauritz W, Spiss C, Draxler V, Sporn P. Indications for tracheotomy in long-term ventilated critically ill patients. Anasth Intensivther Notfallmed 1984; 19: 19-23.
- Kaptanoğlu M, Nadir A. Acquired tracheal lesions in childhood and its surgical management. Türkiye Klinikleri J Surg Med Sci 2006; 2: 22-26.
- Akcan AB, Dursun O. Pediatrik trakeotomi ve ev bakımı. KBB-Forum 2010; 9: 70-7.
- Swift AC, Rogers JH. The changing indications for tracheostomy in children. J Laryngol Otol 1987; 101: 1258-62.
- Rozsasi A, Kühnemann S, Gronau S, Keck T. A single-center 6-year experience with two types of pediatric tracheostomy. Int J Pediatr Otorhinolaryngol 2005; 69: 607-13.
- Carr MM, Poje CP, Kingston L, Kielma D, Heard C. Complications in pediatric tracheostomies. Laryngoscope 2001; 111: 1925-8.
- Koltai JP. Starplasty: a new technique of pediatric tracheotomy. Arch Otolaryngol Head Neck Surg 1998; 124: 1105-11.
- Fry TL, Jones RO, Fischer ND, Pillsbury HC. Comparisons of tracheostomy incisions in a pediatric model. Ann Otol Rhinol Laryngol 1985; 94: 450-3.
- Waddell A, Appleford R, Dunning C, Papsin BC, Bailey CM. The Great Ormond Street protocol for ward decannulation of children with tracheostomy: increasing safety and decreasing cost. Int J Pediatr Otorhinolaryngol 1997; 39(2): 111-18.
- Stern Y, Cosenza M, Walner D, Cotton RT. Management of persistent tracheocutaneous fistula in the pediatric age group. Ann Otol Rhinol Laryngol 1999;108(9): 880-83.
- Fitton C. Nursıng management of a child with a tracheostomy. Pediatr Clin North Am 1994; 41(3): 513-23.
- Barnes LP. Tracheostomy care: preparing parents for discharge. MCN Am J Matern Child Nurs 1992; 17(6): 293.
Ayrıntılar
| Birincil Dil | Türkçe |
|---|---|
| Konular | Çocuk Sağlığı ve Hastalıkları |
| Bölüm | Araştırma Makaleleri |
| Yazarlar | |
| Yayımlanma Tarihi | 25 Haziran 2020 |
| Gönderilme Tarihi | 30 Ekim 2019 |
| Kabul Tarihi | 24 Şubat 2020 |
| Yayımlandığı Sayı | Yıl 2020 Cilt: 17 Sayı: 2 |
