Forbes J Med. 2021; 2(3): 150-153 | DOI: 10.4274/forbes.galenos.2021.29491

Çocuk Yoðun Bakýmda Trakeostomi: Tek Merkez Deneyimi

Gürkan Atay
Saðlýk Bilimleri Üniversitesi, Ümraniye Eðitim ve Araþtýrma Hastanesi, Çocuk Saðlýðý ve Hastalýklarý Kliniði, Ýstanbul, Türkiye

Amaç: Trakeostomi, yoðun bakým ünitesindeki kritik hasta çocuklarda en sýk kullanýlan cerrahi müdahalelerden biridir. Pediatrik trakeostomi; küçük ve esnek trakea, sýnýrlý cerrahi alan ve anestezi riski nedeniyle daha zordur. Bu çalýþma üçüncü basamak bir çocuk yoðun bakým ünitesinde (ÇYBÜ) trakeostominin endikasyonlarýný, komplikasyonlarýný ve sonuçlarýný analiz etmek amacýyla yapýlmýþtýr.
Yöntem: Bu çalýþmada, üçüncü basamak bir üniversite hastanesi ÇYBÜ’de Ocak 2016 ile Aralýk 2020 tarihleri arasýnda trakeostomi açýlan hastalarýn verileri retrospektif olarak deðerlendirildi.
Bulgular: Toplam 43 pediatrik hastaya trakeostomi açýldý. Hastalarýn yaþ ortalamasý 52,2 ay (minimum: 2, maksimum: 192 ay) olarak bulundu. Ortalama Pediatrik Mortalite Riski: 20,6 (minimum: 8, maksimum: 33), ortalama trakeostomi açýlma süresi: 24 gün (minimum: 2, maksimum: 52) idi. Trakeostomi için en yaygýn endikasyon nöromüsküler problemlere sekonder uzamýþ mekanik ventilasyondu (MV) (34 olgu, %79,1), bunu üst hava yolu obstrüksiyonu (9 olgu, %20,9) izledi. Hastalarýn 35’i (%81,4) taburcu edilirken, 8’i (%18,6) yoðun bakým izlemi sýrasýnda kaybedildi.
Sonuç: Trakeostomi, ÇYBÜ’de özellikle uzamýþ MV olgularýnda güvenle uygulanabilecek cerrahi bir müdahaledir. Trakeostominin açýlma süresi, pediatrik yoðun bakým uzmaný tarafýndan hasta bazlý deðerlendirilerek karar verilmelidir.

Anahtar Kelimeler: Trakeostomi, çocuk yoðun bakým, uzamýþ mekanik ventilasyon

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Tracheostomy in Pediatric Intensive Care: A Single Center Experience

Gürkan Atay
Health Sciences University, Umraniye Training and Research Hospital, Clinic of Pediatrics, Istanbul, Turkey

Objective: Tracheostomy is one of the most frequently used surgical interventions in critically ill children in the intensive care unit. Pediatric tracheostomy; The small and flexible trachea is more difficult because of the limited surgical space and the risk of anesthesia. This study was conducted to analyze the indications, complications and outcomes of tracheostomy in a tertiary pediatric intensive care unit (PICU).
Methods: In this study, the data of patients who underwent tracheostomy in the PICU of a tertiary university hospital between January 2016 and December 2020 were evaluated retrospectively.
Results: A total of 43 pediatric patients underwent tracheostomy. The mean age of the patients was 52.2 months (minimum: 2, maximum: 192 months). Mean Risk of Pediatric Mortality: 20.6 (minimum: 8, maximum: 33), mean tracheostomy opening time: 24 days (minimum: 2, maximum: 52). The most common indication for tracheostomy was prolonged mechanical ventilation (MV) secondary to neuromuscular problems (34 cases, 79.1%), followed by upper airway obstruction (9 cases, 20.9%). While 35 (81.4%) of the patients were discharged, 8 (18.6%) died during intensive care follow-up.
Conclusion: Tracheostomy is a surgical intervention that can be safely applied in the PICU, especially in cases of prolonged MV. The opening time of the tracheostomy should be decided on a patient basis by the pediatric intensive care specialist.

Keywords: Tracheostomy, pediatric intensive care, prolonged mechanical ventilation

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