Öz
Giriş:
Konjenital kalp cerrahisi geçiren çoğu hasta cerrahi sonrasında ekstübasyonu tolere etmektedir, fakat bazı hastalarda entübasyon süresi uzamakta, ventilatörden ayrılma zorlaşmaktadır. Hastaların ventilatörden ayrılamama sebepleri arasında konjenital hava yolu anomalileri, laringomalazi, postoperatif havayolu komplikasyonları, DiGeorge Sendromu (22q11 delesyonu) gibi havayolu ve yüz anomalileri ile ilişkili genetik sendromlar sayılabilir. Bu çalışmanın ile konjenital kalp cerrahisi sonrası kronik solunum yetmezliği sebebiyle trekeostomi ihtiyacı duyulan hastaların sonuçlarını, hastane içi ve taburculuk sonrası mortalitede mevcut risk faktörlerini tanımlamayı amaçladık.
Gereç ve Yöntem:
…………………………… Çocuk Kalp ve Damar Cerrahisi Kliniğinde Şubat 2019-Şubat 2023 tarihleri arasında KKH nedeniyle ameliyat edilen 1382 hastanın dosyaları retrospektif olarak tarandı. Hastaların yaşı, cinsiyeti, vücut ağırlığı, kardiyak tanı, cerrahi girişim, yoğun bakımda kalış süresi, ekstübasyon girişimi sayısı, ventilatörde toplam kalış süresi, taburculukta ventilatör ihtiyacı, trakeostomiden ayrılma oranları ve süresi trakeostomiden ayrılma ve mortalite oranları, hasta dosyalarından ve hastane veri tabanından elde edildi.
Sonuçlar:
Dört yıllık çalışma döneminde ameliyat edilen 1382 hastanın 15'ine trakeostomi uygulandı. Trakeostomi öncesi ortalama (SD) ventilasyon süresi 35 gündü (IQR= 19 – 47). Hastalarda ortanca takip süresi 224 gündü (IQR=116-538). Üç hasta dekanüle edildi ve altı hasta öldü. Altı hastada ölüm nedenleri arasında sepsis (2), kardiyak instabilite (1), nörolojik komplikasyonlar (2) ve pulmoner hemoraji (1) vardı.
Hastalarda trakeostomi sonrası medyan taburcu olma süresi 51 gündü (IQR= 33.50 – 147).
Sekiz hasta (%53.3) ev tipi ventilatör ile taburcu edildi. Hastanede ilk kalışları sırasında ölen çocuklar için ölüm nedenleri genellikle çok faktörlüydü. Altı hastada (%40) mortalite görüldü.
Tartışma:
Çocuklarda kalp cerrahisi sonrası trakeostomi ihtiyacı erken ve geç mortalitede önemli rol oynamaktadır. Ventilatöre bağlı kronik solunum yetmezliği, çocukluk çağı trakeostomilerinin en yaygın nedenidir. Pediatrik popülasyonda trakeostomi için en uygun zamanlamanın belirlenmesinin uzamış ventilasyonu ve trakeostomiye bağlı morbiditeleri azaltmada etkili olacağına inanıyoruz.
Anahtar Kelimeler
konjenital kalp hastalıkları trakeostomi kronik solunum yetmezliği kardiyak cerrahi
Destekleyen Kurum
yok
Proje Numarası
yok
Teşekkür
yok
Kaynakça
- 1. Cotts T, Hirsch J, Thorne M, Gajarski R. Tracheostomy after pe- diatric cardiac surgery: frequency, indications, and outcomes. J Thorac Cardiovasc Surg. 2011 Feb;141(2):413-8.
- 2. Polito A, Patorno E, Costello JM, Salvin JW, Emani SM, Rajago- pal S, et al. Perioperative factors associated with prolonged mechanical ventilation after complex congenital heart surgery. Pediatr Crit Care Med. 2011 May;12(3):e122-6.
- 3. Székely A, Sápi E, Király L, Szatmári A, Dinya E. Intraoperative and postoperative risk factors for prolonged mechanical ven- tilation after pediatric cardiac surgery. Paediatr Anaesth. 2006 Nov;16(11):1166-75.
- 4. Hsu CL, Chen KY, Chang CH, Jerng JS, Yu CJ, Yang PC. Timing of tracheostomy as a determinant of weaning success in critically ill patients: a retrospective study. Crit Care. 2005 Feb;9(1):R46-52.
- 5. Mahida JB, Asti L, Boss EF, Shah RK, Deans KJ, Minneci PC, et al. Tracheostomy Placement in Children Younger Than 2 Years: 30-Day Outcomes Using the National Surgical Quality Improve- ment Program Pediatric. JAMA Otolaryngol Head Neck Surg. 2016 Mar;142(3):241-6.
- 6. Rosner E, Mastropietro CW. Prior cardiac surgery is independent- ly associated with decreased survival following infant tracheos- tomy. Respir Care. 2015 Jan;60(1):47-55.
- 7. Challapudi G, Natarajan G, Aggarwal S. Single-center experience of outcomes of tracheostomy in children with congenital heart disease. Congenit Heart Dis. 2013 Nov-Dec;8(6):556-60.
- 8. Edwards JD, Kun SS, Keens TG, Khemani RG, Moromisato DY. Children with corrected or palliated congenital heart dis- ease on home mechanical ventilation. Pediatr Pulmonol. 2010 Jul;45(7):645-9.
- 9. Hoskote A, Cohen G, Goldman A, Shekerdemian L. Tracheos- tomy in infants and children after cardiothoracic surgery: indi- cations, associated risk factors, and timing. J Thorac Cardiovasc Surg. 2005 Oct;130(4):1086-93.
Öz
Introduction
A small number of children with repaired congenital heart defects may require a tracheostomy for ongoing ventilatory support. Congenital airway anomalies, laryngomalacia, postoperative airway complications and genetic syndromes associated with airway and facial anomalies, such as DiGeorge Syndrome (22q11 deletion), can be counted among the reasons why patients are unable to be weaned from the ventilator. In this study, we aimed to define the outcomes of patients who required a tracheostomy due to chronic respiratory failure after congenital heart surgery, and the existing risk factors for in-hospital and post-discharge mortality.
Materials and methods
The files of 1382 patients who underwent surgery due to CHD in the Pediatric Cardiovascular Surgery Clinic in ……………., between February 2019 and February 2023, were retrospectively scanned. Patients’ age, gender, body weight, cardiac diagnosis, surgical intervention, length of stay in the intensive care unit, number of extubation attempts, total length of stay on the ventilator, need for ventilator at discharge, rates of weaning from tracheostomy and time of weaning from tracheostomy and mortality rates, were obtained from patient files and hospital database.
Results
Tracheostomy was performed in 15 of 1382 patients who underwent surgery during the four year study period. Mean (SD) duration of ventilation prior to tracheostomy was 35 days (IQR= 19 – 47). The median follow up time in patients was 224 days (IQR=116-538). Three patients were decannulated and six had died. Causes of death in six patients included sepsis (2), cardiac instability (1), neurological complications (2) and pulmonary haemorraghia (1).
The median time to discharge after tracheostomy in patients was 51 days (IQR= 33.50 – 147).
Eight patients (53.3%) were discharged on home ventilation. Causes of deaths were often multifactorial for children who died during their initial hospital stay. Mortality was seen in six patients, a rate of 40%.
Conclusion
The need for tracheostomy after cardiac surgery plays an important role in early and late mortality in children. Ventilator-dependent chronic respiratory failure is the most common cause of childhood tracheostomies. We believe that determining the optimal timing for tracheostomy in the pediatric population will be effective in reducing prolonged ventilation and tracheostomy-related morbidities.
Anahtar Kelimeler
congenital heart diseases tracheostomy chronic respiratory failure cardiac surgery
Proje Numarası
yok
Kaynakça
- 1. Cotts T, Hirsch J, Thorne M, Gajarski R. Tracheostomy after pe- diatric cardiac surgery: frequency, indications, and outcomes. J Thorac Cardiovasc Surg. 2011 Feb;141(2):413-8.
- 2. Polito A, Patorno E, Costello JM, Salvin JW, Emani SM, Rajago- pal S, et al. Perioperative factors associated with prolonged mechanical ventilation after complex congenital heart surgery. Pediatr Crit Care Med. 2011 May;12(3):e122-6.
- 3. Székely A, Sápi E, Király L, Szatmári A, Dinya E. Intraoperative and postoperative risk factors for prolonged mechanical ven- tilation after pediatric cardiac surgery. Paediatr Anaesth. 2006 Nov;16(11):1166-75.
- 4. Hsu CL, Chen KY, Chang CH, Jerng JS, Yu CJ, Yang PC. Timing of tracheostomy as a determinant of weaning success in critically ill patients: a retrospective study. Crit Care. 2005 Feb;9(1):R46-52.
- 5. Mahida JB, Asti L, Boss EF, Shah RK, Deans KJ, Minneci PC, et al. Tracheostomy Placement in Children Younger Than 2 Years: 30-Day Outcomes Using the National Surgical Quality Improve- ment Program Pediatric. JAMA Otolaryngol Head Neck Surg. 2016 Mar;142(3):241-6.
- 6. Rosner E, Mastropietro CW. Prior cardiac surgery is independent- ly associated with decreased survival following infant tracheos- tomy. Respir Care. 2015 Jan;60(1):47-55.
- 7. Challapudi G, Natarajan G, Aggarwal S. Single-center experience of outcomes of tracheostomy in children with congenital heart disease. Congenit Heart Dis. 2013 Nov-Dec;8(6):556-60.
- 8. Edwards JD, Kun SS, Keens TG, Khemani RG, Moromisato DY. Children with corrected or palliated congenital heart dis- ease on home mechanical ventilation. Pediatr Pulmonol. 2010 Jul;45(7):645-9.
- 9. Hoskote A, Cohen G, Goldman A, Shekerdemian L. Tracheos- tomy in infants and children after cardiothoracic surgery: indi- cations, associated risk factors, and timing. J Thorac Cardiovasc Surg. 2005 Oct;130(4):1086-93.
Ayrıntılar
| Birincil Dil | İngilizce |
|---|---|
| Konular | Sağlık Kurumları Yönetimi |
| Bölüm | Araştırma Makalesi |
| Yazarlar | |
| Proje Numarası | yok |
| Yayımlanma Tarihi | 30 Haziran 2023 |
| Yayımlandığı Sayı | Yıl 2023 Cilt: 14 Sayı: 2 |
Kaynak Göster
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