Tracheostomy in Pediatric Intensive Care Unit: Experience from Eastern India (original) (raw)

Tracheostomy in Pediatric Intensive Care Unit: When and Where?

Iranian Journal of Pediatrics, 2016

Background: Tracheostomy was first observed in Egyptian drawings in 3600 BC and performed frequently during the 1800's diphtheria epidemic. Objectives: The aim of this study was to elucidate the indications, complications, mortality rate, and the effect of pediatric tracheostomy on length of PICU or hospital stay. Materials and Methods: Demographic characteristics, diagnosis at admission, duration of ventilation of 152 patients were analyzed retrospectively. Results: The most common tracheostomy indication was prolonged intubation. The mean duration of mechanical ventilation before tracheostomy was 23.8 days. Forty five percent of the tracheostomy procedures were performed at bedside. Neither the place nor the age had any effect on the development of complications (P = 0.701, P = 0.622). The procedure enabled 62% of the patients to be discharged from hospital. Conclusions: Tracheostomy facilitates discharge and weaning of mechanical ventilation. Although the timing of tracheostomy has to be determined for each individual patient, three weeks of ventilation seems to be a suitable period for tracheostomy. Tracheostomy can be performed at bedside safely but patient selection should be made carefully.

Tracheostomy in Pediatric Intensive Care Unit—A Two Decades of Experience

Indian Journal of Critical Care Medicine, 2021

Aim and objective: To study the profile, indications, related complications, and predictors of decannulation and mortality in patients who underwent tracheostomy in the pediatric intensive care unit (PICU). Materials and methods: Retrospective analysis of prospectively collected data of tracheostomies was done on patients admitted at PICU. Demographics, primary diagnosis, indication of tracheostomy, and durations of endotracheal intubation, mechanical ventilation, and tracheostomy cannulation were recorded. The indication was recorded in one of the four categories-upper airway obstruction (UAO), central neurological impairment (CNI), prolonged mechanical ventilation, and peripheral neuromuscular disorders). Results: Two hundred ninety cases were analyzed. UAO (42%) and CNI (48.2%) were main indications in the halves of the study period, respectively. Decannulation was successful in 188 (64.8%) patients. Seventy-seven percentage UAO patients were decannulated successfully [OR (odds ratio); 95% CI (confidence interval), 2.647; 1.182-5.924, p = 0.018]. Age <1 year (0.378; 0.187-0.764; p = 0.007), nontraumatic, noninfectious central neurological diseases (0.398; 0.186-0.855; p = 0.018), and malignancy (0.078; 0.021-0.298; p <0.001), durations of posttracheostomy ventilation (0.937; 0.893-0.983; p = 0.008), and stay in the PICU (0.989; 0.979-0.999; p = 0.029) were predictors of unsuccessful decannulation. There were 91 (31.4%) deaths. Age <1 year (2.39 (1.13-5.05; p = 0.02), malignancy (17.55; 4.10-75.11; p <0.001), durations of posttracheostomy ventilation (1.06; 1.006-1.10; p = 0.028), and hospital stay (1.007; 1.0-1.013; p = 0.043) were independent predictors of mortality. Indication of UAO favored survivor (0.24; 0.09-0.57; p <0.001). Conclusion: The indications for tracheostomy in children had changed over the years. Infancy, primary diagnosis, length of posttracheostomy ventilation, and stay in the PICU and hospital were independent predictors of decannulation and mortality. What This Adds Similar to developed countries, the age at the time of tracheostomy and indication are changing. Inability to decannulate and mortality were associated with the age of a child at the time of tracheostomy, indication, medical diagnosis, and duration of postprocedure mechanical ventilation and stay in the hospital.

Tracheostomy in pediatric critically ill patients

Journal of Pediatric Intensive Care, 2015

The indications for and timing of tracheostomy in children have changed significantly over recent years, and no consensus has been gathered in that regard. The purpose of this study is to present a series of critically ill patients who required a tracheostomy. All critically ill patients required a tracheostomy between 1 June 2009 and 31 March 2012. It is a retrospective, observational, descriptive study. A total of 18 patients underwent tracheostomy during the period under study. The most common indication was neuromuscular compromise. The average duration of mechanical ventilation before placement of a tracheostomy was 23.8 days (0-58 days). The complications observed were minor, and no patients died from tracheostomy-related causes. All parents were trained in airway management and cardiopulmonary resuscitation. There were no serious tracheostomy-related complications in critically ill pediatric patients. The procedure was effective in the management of patients with respiratory failure, patients with neuromuscular compromise and children with upper airway obstruction.

Clinical Study Retrospective Analysis of Pediatric Tracheostomy

2015

Purpose.This paper reviews analyses for tracheostomy within our patient population over the last 6 years.Methods.We conducted a retrospective chart review of consecutive patients undergoing tracheostomy at the tertiary Dicle University Medical hospital, Turkey, from January 2006 to December 2012. Patient age, sex, emergency, planned tracheostomy, indications, complications, and decannulation time were all assessed. Results. Fifty-six (34 male, 22 female) adult Pediatric patients undergoing tracheostomy between 2006 and 2013 were investigated. The most common indication for tracheostomy was upper airway obstruction (66.7%), followed by prolonged intubation (33.3%). Mean decannulation times after tracheostomy ranged between 1 and 131 days, the difference being statistically significant (P = 0.040). There was no significant difference in terms of mean age (9.8 ± 6.0; P = 0.26). There was also no statistical difference between emergency and planned tracheotomies (P = 0.606). Conclusion....

Pediatric bedside tracheostomy in the pediatric intensive care unit: six-year experience

The Turkish journal of pediatrics

In this study, we evaluated the experience of a single center pediatric intensive care unit in pediatric bedside tracheostomies performed during a six-year period. Thirty-one bedside tracheostomies were performed on 31 patients aged 2 months to 18 years. The major indication for tracheostomy was prolonged ventilator dependence. Twenty-two complications, 6 major and 16 minor, were observed in 18 patients. Early complications were observed in 5 patients and all were managed immediately without serious outcomes. Ten patients died during the study period and only one death was directly related to the tracheostomy; the remaining 9 patients died due to their underlying disease. Eleven patients were successfully decannulated, 12 patients were discharged home with their tracheostomies and 5 of these 12 patients required home ventilation. Although children who required tracheostomy had a high overall mortality (32.3%), the prognosis of these patients depends primarily on the underlying medic...

Retrospective Analysis of Pediatric Tracheostomy

Advances in Otolaryngology, 2014

Purpose. This paper reviews analyses for tracheostomy within our patient population over the last 6 years. Methods. We conducted a retrospective chart review of consecutive patients undergoing tracheostomy at the tertiary Dicle University Medical hospital, Turkey, from January 2006 to December 2012. Patient age, sex, emergency, planned tracheostomy, indications, complications, and decannulation time were all assessed. Results. Fifty-six (34 male, 22 female) adult Pediatric patients undergoing tracheostomy between 2006 and 2013 were investigated. The most common indication for tracheostomy was upper airway obstruction (66.7%), followed by prolonged intubation (33.3%). Mean decannulation times after tracheostomy ranged between 1 and 131 days, the difference being statistically significant ( = 0.040). There was no significant difference in terms of mean age (9.8 ± 6.0; = 0.26). There was also no statistical difference between emergency and planned tracheotomies ( = 0.606). Conclusion. In our patient population, there was a significant decline in the number of tracheotomies performed for prolonged intubation and an increasing number of patient tracheostomy for upper airway obstruction. According to the literature, permanent decannulation rates were slightly higher with an increase in genetic diseases such as neuromuscular disease.

Pediatric tracheostomy: indications and outcomes from Indian tertiary care centre

International Journal of Otorhinolaryngology and Head and Neck Surgery

Tracheostomy is a frequently performed procedure for critically ill patients who require prolonged ventilatory support and for airway control in cases of respiratory insufficiency and retained secretions. 1 Pediatric patients are medically vulnerable and reviews have shown substantially higher rates of complications with almost 2-3 times more morbidity and mortality than adults. 2 In past decade, pediatric tracheostomy has become safer with better defined indications. The indications of pediatric tracheostomy have changed from infective causes to airway obstruction and anomalies, long-term ventilation requirement, and underlying neuromuscular or respiratory problems. 3,4 The present tertiary care centre, which is also a referral centre for pediatric patients, receive many such patients who are indicated for tracheostomy. The aim of this study is to identify the indications, surgical issues, complications and outcome in children who required tracheostomy.

Unraveling the Evolving Trends of Pediatric Tracheostomy- An Overview at a Tertiary Care Center

Acta Scientific Otolaryngology

Otolaryngologists have long been concerned with pediatric airway care because of the vast range of problems that can arise in these situations. Tracheostomy was practiced in Greece, according to historical documents, and ever since it has served as the cornerstone of medical administration. Through bypassing any upper airway obstructive pathology, pediatric tracheostomy lessens dead space and, hence, the lung work load. It also gives access to suction and airway clearing. As medical technology has advanced throughout time, the indications and length of tracheostomies done on pediatric patients have changed. Our aim was to study the indications and the timing of performing tracheostomy in paediatric population at a tertiary care set up and to assess the complications and outcome for successful decannulation. The most frequent cause for prologed tracheostomy was Guillain Barre in children. They had good outcomes, including successful decannulation once their general health stabilized. The most frequent cause of death in our research population was cardiac arrest, with tube displacement and lower respiratory tract infection as the most frequent sequelae. Longer tracheostomy durations with a delay in decannulation were linked to longer PICU stays and longer hospital stays. The decannulation was successful in almost all instances, but the socioeconomic status, carer awareness, and general health of the patient determined the speed of weaning off and post-tracheostomy rehabilitation. Even in a developing nation like ours, improved access to intensive care units and medical progress have changed the way that children tracheostomies are thought of.

Early and long term outcome after tracheostomy in children: Tracheostomy in children

Pediatrics International, 2010

Background: Tracheostomy has become an increasingly important issue for children discharged with primary or secondary respiratory problems. Despite the known advantages, considerable controversy remains regarding the appropriate indications, timing, and results of tracheostomy, in the context of home care. The aims of this study were to retrospectively evaluate our experience with tracheostomy and to consider problems related to this procedure, both in the hospital and after discharge.Methods: We performed a retrospective chart review of all patients receiving new tracheostomies in our department, over a 5-year period.Results: Thirty tracheostomies were performed in 30 patients over a 5-year period. The overall tracheostomy rate among ventilated patients was 3.4%. Most (90%) of the tracheostomies were placed after mechanical ventilation. Patients who were successfully decannulated spent significantly less time in intensive care, both before (P= 0.01) and after surgical tracheostomy procedure (P= 0.034) when compared to the patients discharged with tracheostomy, either with or without home ventilation. These patients also had shorter total intensive care admissions (P= 0.002) and shorter hospitalizations overall (P= 0.013). Successful decannulation was achieved in five patients (17%). The cumulative mortality rate was 17% in the pediatric intensive care unit, 20% within 30 days, and 41% within 1 year.Conclusions: Patients admitted with anatomic or functional airway problems had higher decannulation rates. Patients who were successfully decannulated also had significantly shorter PICU stays prior to tracheostomy. In patients with neurologic and muscular disease, or with chronic heart/lung disease, decannulation rates are very low, and these patients have a higher mortality risk after discharge.