Tracheostomy after pediatric cardiac surgery: Frequency, indications, and outcomes (original) (raw)
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Unplanned tracheostomy following pediatric cardiac surgery
Otolaryngology Head and Neck Surgery Official Journal of American Academy of Otolaryngology Head and Neck Surgery, 2009
To identify factors contributing to unplanned tracheostomy following cardiac surgery in children under 12 months without prior airway support. METHODS: Case series with chart review. RESULTS: Eleven patients were identified (eight male, three female). Eight were term, three preterm. Four had syndromes associated with cardiac disease. Age at cardiac surgery was 2.2 (0.1-5.2) months. Time between surgery and tracheostomy was 1.2 (0-3) months. Two groups were identified. The first had tracheobronchomalacia as the primary diagnosis (n ϭ 9). Time postsurgery for tracheostomy was 1.2 (0.5-3) months. The second had bilateral vocal fold paralysis (n ϭ 2). Both children had cardiac procedures that have recognized risk to the left recurrent laryngeal nerve (RLN). Both had cannulation of the right internal jugular vein at the time of surgery. Tracheostomy occurred within three days of the cardiac procedure. CONCLUSION: Investigations for tracheobronchomalacia should occur if a child continues to fail ventilator weaning or extubation following cardiac surgery. Risk of right RLN injury due to right vascular instrumentation should be minimized in left RLN prone procedures.
Indications and Outcomes of Tracheostomy in Children After Congenital Heart Surgery
Turkish Journal of Pediatric Emergency and Intensive Care Medicine
Kardiyovasküler cerrahi sonrası çocukların çok az bir kısmında uzun süreli mekanik ventilasyon desteği ve trakeostomi gerekmektedir. Bu çalışma ile trakeostominin endikasyonlarını, zamanlamasını ve sonuçlarını tanımlamayı hedefliyoruz. Yöntemler: Ocak 2010-Aralık 2019 tarihleri arasında kalp cerrahisi sonrası trakeostomi gerektiren hasta verileri geriye dönük olarak değerlendirildi. Hastaların preoperatif özellikleri, trakeostomi endikasyonları, trakeostomi açılma zamanı ve klinik sonuçları analiz edildi. Bulgular: Kalp cerrahisi uygulanan 2,459 hastanın 12'sine (%0,5) trakeostomi açıldı. Bu hastaların kalp cerrahisi sırasında ortanca yaşı 210 gün (çeyrek değerler genişliği: 75-262 gün) idi. Kalp cerrahisi ile trakeostomi arasındaki ortalama süre 25 gündü (çeyrek değerler genişliği: 15-47 gün). Trakeostomi için en sık endikasyon postoperatif gelişen diyafragma paralizisi (%42) idi. Hastaların %41,6'sında genetik sendrom veya en az bir kardiyak olmayan morbidite mevcuttu. Mekanik ventilatörde kalış süresi değerlendirildiğinde, çocuk yoğun bakım yatışlarının ilk 30 gün içinde trakeostomi açılan hastaların mekanik ventilatörde kalma süresi, 30. gün sonrasında trakeostomi açılan hasta grubuna göre daha kısaydı (sırasıyla 30 gün, 60 gün, p=0,035). Trakeostomiden sonra çocuk yoğun bakım ünitesinde ortalama kalış süresi 41 gündü (aralık, 21-289 gün). Doğuştan kalp cerrahisi sonrası trakeostomi açılan 12 hastanın 6'sı (%50) ortalama 179 gün (aralık, 34-463 gün) sonra dekanüle edildi. İzlem sonrası birinci yılda operatif mortalite %8,3 (1/12) ve genel mortalite %8,3 (1/12) idi. Sonuç: Doğuştan kalp cerrahisi sonrası trakeostomi ihtiyacı olan hastalarda erken trakeostomi işlemi, pozitif basınçlı ventilasyondan ayrılma sürecini kolaylaştırır ve pozitif basınçlı ventilasyon süresini kısaltabilir. Anahtar Kelimeler: Trakeostomi, doğuştan kalp cerrahisi, uzamış mekanik ventilasyon, çocuk Introduction: In a minority of children after cardiovascular surgery may require prolonged mechanical ventilatory support and tracheostomy. We aim to describe indications, timing and, outcomes of the tracheostomy. Methods: A retrospective review of 12 children requiring tracheostomy after cardiac surgery between January 2010-December 2019 was performed. The patients' characteristics, indications and timing for tracheostomy, and survival were reviewed. Results: After cardiac surgery, 12 (0.5%) of 2.459 patients with a median age at surgery of 210 days (interquartile range: 75-262 days) underwent tracheostomy. The median time between cardiac surgery and tracheostomy was 25 days (interquartile range: 15-47 days). Diaphragmatic paralysis was the most common (42%) indication for tracheostomy. Genetic syndrome or at least one noncardiac morbidity was present in 41.6% of patients. The duration of mechanical ventilation was shorter in patients who had tracheostomy within 30 days compared with >30 days following intubation (30 vs. 60 days, p=0.035). The median length of pediatric intensive care unit stays after the tracheostomy was 41 days (range, 21-289 days). Among all patients with congenital heart surgery undergoing tracheostomy, 6 (50%) of 12 were decannulated after a median time of 179 days (range, 34-463 days). The operative mortality was 8.3% (1/12) and the overall mortality during the first year of followup was 8.3% (1/12). Conclusion: An early tracheostomy procedure may facilitates the weaning process and shorten the duration of positive pressure ventilation.
The Outcomes of Tracheostomy in Pediatric Cardiac Surgical Patients
Journal of Cardiac Critical Care TSS, 2021
Objectives To describe the outcomes of postoperative tracheostomy and determine the predictors of survival. Design Prospective, observational study. Setting Cardiac surgical intensive care unit of a tertiary care hospital. Participants All pediatric patients below 10 years of age who underwent tracheostomy after cardiac surgery from January 2019 to December 2019. Different variables were compared between survivors and nonsurvivors. Intervention Tracheostomy. Results Among 1084 pediatric patients who underwent cardiac surgery during the study period, 41 (3.7%) received tracheostomy. Survival rate was 71%.Earlier, sternal closure (SC) (p = 0.04), acute kidney injury (AKI) (p = 0.001), serum C-reactive protein (CRP) (p = 0.007), duration of total parenteral nutrition (TPN) (p = 0.005) and days of feed interruption (FI) (p = 0.02), activated partial thromboplastin time (aPTT) before tracheostomy (p = 0.006), and bleeding from tracheostomy site (p = 0.02) were significantly low in the su...
Tracheostomy Following Surgery for Congenital Heart Disease: A 14-year Institutional Experience
World journal for pediatric & congenital heart surgery, 2016
Tracheostomy following congenital heart disease (CHD) surgery is a rare event and associated with significant mortality. Hospital survival has been reported from 20% to 40%. Late mortality for these patients is not well characterized. We performed a retrospective observational study of patients who had a tracheostomy following CHD surgery (excluding isolated patent ductus arteriosus ligation) between January 2000 and December 2013. Patients were categorized into single-ventricle or biventricular physiology groups. Demographics, genetic syndromes, pulmonary disease, and comorbidities were collected. Outcomes including hospital survival, long-term survival, and weaning from positive pressure ventilation are reported. Bivariate and time-to-event models were used. Over a 14-year period, 61 children (0.9% incidence) had a tracheostomy placed following CHD surgery. There were 12 single-ventricle patients and 49 biventricular patients. Prematurity, genetic syndromes, lung/airway disease, a...
Tracheostomy in Postoperative Pediatric Cardiac Surgical Patients—The Earlier, the Better
Journal of Cardiac Critical Care TSS
Objectives This study was aimed to assess the benefits of early tracheostomy (ET) compared with late tracheostomy (LT) on postoperative outcomes in pediatric cardiac surgical patients. Design Present one is a prospective, observational study. Setting The study was conducted at a cardiac surgical intensive care unit (ICU) of a tertiary care hospital. Participants All pediatric patients below 10 years of age, who underwent tracheostomy after cardiac surgery from January2019 to december2019, were subdivided into two groups according to the timing of tracheostomy: “early” if done before 7 days or “late” if done after 7 days postcardiac surgery. Interventions ET versus LT was measured in the study. Results Out of all 1,084 pediatric patients who underwent cardiac surgery over the study period, 41 (3.7%) received tracheostomy. Sixteen (39%) patients underwent ET and 25 (61%) underwent LT. ET had advantages by having reduced risk associations with the following variables: preoperative hosp...
Tracheostomy in Infants after Cardiac Surgery: Indications, Timing and Outcomes
Clinical Cardiology and Cardiovascular Interventions, 2021
Objective: There is little consensus on the indications and optimal timing of tracheostomy in the pediatric population. Our primary aim was to determine if early tracheostomy improves patient outcomes (between 10th and 15th postoperative day). Methods: A retrospective review of 84 neonates and infants requiring tracheostomy after cardiac surgery between January 1997 and December 2019 was performed. Indications and timings for tracheostomy, and risk factors for mortality were analyzed using Cox regression analysis. The receiver operating characteristic curve analysis, Youden’s index, sensitivity and specificity plot were performed to determine the optimal cut-off point of the timing of tracheostomy. Results: Twenty-five (29.76%) neonates and 59 (70.23%) infants with a median weight 7.6 kg (IQR: 3.1-9.25 kg) were studied. Extubation failure and unsuccessful weaning from ventilator occurred in 45 (53.6%) and 39 (46.4%) patients respectively. The timing of tracheostomy of 15 days as the...
The Annals of Thoracic Surgery, 2009
Background. Patients with complex congenital heart disease associated with tracheobronchomalacia (TBM) remain difficult to manage after cardiac surgery. We studied the influence of TBM on the outcomes of pediatric patients after cardiac surgery for congenital heart disease to determine how to manage these patients better. Methods. Twenty-two consecutive pediatric patients who had TBM diagnosed by bronchoscopy or dynamic contrast bronchography before or after cardiac surgery for congenital heart disease during a 5.5-year period were compared with an age-and procedure-matched control group operated on during the same period. Patients diagnosed postoperatively were investigated after a second failed extubation. Patients were managed by oxygen administration, endotracheal suctioning, and positive end-expiratory or continuous positive airway pressure through a nasotracheal tube or tracheostomy. Results. There were 4 deaths within 1 year of surgery, all in the study group, with 2 early (neither of which appeared related to TBM) and 2 late. The estimated survival at 5 years was 82% (95% confidence interval, 59% to 93%) for the study group compared with 100% for control patients (p ؍ 0.012). All deaths occurred in patients undergoing palliative procedures (p ؍ 0.0004), and both children who underwent redo operations died (p ؍ 0.02). Postoperatively, 50% of children with TBM required prolonged ventilation and tracheostomy. Compared with control patients the average postoperative ventilation time, pediatric intensive care unit stay, and hospital stay were 6.5, 11.5, and 20 days versus 1, 2, and 6.5 days, respectively (p < 0.001). Conclusions. Although associated with longer postoperative ventilation time, pediatric intensive care unit stay, hospital stay, and mortality, outcomes after cardiac procedures in children with TBM are acceptable. Palliative and redo procedures in this group of patients are associated with significantly higher risk of death.
Frequency and Indications for Tracheostomy and Gastrostomy After Congenital Heart Surgery
Pediatric Cardiology, 2009
Patients undergoing congenital heart surgery may occasionally require additional surgical procedures in the form of tracheostomy and gastrostomy. These procedures are often performed in an attempt to diminish hospital morbidity and length of stay. We reviewed the Web-based medical records of all patients undergoing congenital heart surgery at Miami Children's Hospital from February 2002 through August 2007. Patients who were deemed preterm and had undergone closure of a patent ductus arteriosis were eliminated. The records of all other patients were queried for the terms gastrostomy, g-tube, Nissan, fundal plication, tracheostomy, or tracheotomy. Patients' medical records in which these terms appeared in any portion were completely reviewed. There were 1660 congenital heart operations performed in the study period. There were 592 operations performed on patients whose age ranged from 1 month to 1 year and 441 neonatal operations. Mortality was 2%. Median postoperative stay was 8 days (range, 1-191 days), 12 days for neonates (range, 3-142 days), and 19 days for neonates undergoing RACHS-1 category 6 operations (range, 4-142 days). Tracheostomies were performed in four patients (0.2%). Gastrostomies were performed on eight patients (0.4%), representing 0.8% of patients \1 year of age, 1.4% of neonates, and 2.4% of patients undergoing RACHS-1 category 6 operations. The rate of patients undergoing either tracheostomy or gastrostomy after congenital heart surgery at our institution was quite low. Avoidance of either of these two procedures was achieved without increased morbidity or length of stay. The rate at which these procedures need to be performed may reflect the magnitude of the patients' lifetime trauma related to their underlying condition and acute and total surgical experiences.