Tracheostomy in Children: Experience of a Tertiary Pediatric Intensive Care Unit

Abstract

Correspondence (İletişim): Muhterem Duyu, M.D. Medeniyet Universitesi Goztepe Egitim ve Arastirma Hastanesi Cocuk Yogun Bakim Unitesi Istanbul, Turkey Phone (Telefon): +90 555 674 56 61 E-mail (E-posta): [email protected] Submitted Date (Başvuru Tarihi): 29.07.2019 Accepted Date (Kabul Tarihi): 05.08.2019 Copyright 2019 Haydarpaşa Numune Medical Journal OPEN ACCESS This is an open access article under the CC BY-NC license (http://creativecommons.org/licenses/by-nc/4.0/). 282 Duyu, Tracheostomy Experience / doi: 10.14744/hnhj.2019.68926 gth of stay in pediatric intensive care units, and improved oral hygiene [5, 6]. When the publications related to tracheostomy application in the pediatric age group are examined, there are different approaches to the issues, such as timing, indication, applied technique, home care in opening tracheostomy [5, 6]. The prognosis of patients undergoing tracheostomy varies with age, associated comorbidity factors, patient anatomy, the experience level of the unit, the opening time of tracheostomy and the technique used [4, 6, 7]. The increase in the number of patients monitored with home-type mechanical ventilator and tracheostomy support allowed us to evaluate the long-term results after discharge from the intensive care unit. Various studies have been conducted on patients in the home monitoring program requiring chronic respiratory support due to muscle or lung disease and their long-term outcomes [8-10]. There are several studies showing that children connected to the chronic respiratory device can be managed successfully with a good home monitoring program and follow-up method despite higher mortality rates in diseases with poor prognosis [10, 11]. The aims of home monitoring of he children who were followed up by tracheostomy were to extend their life span, to prevent the occurrence of additional disease(s), to accelerate the process of physical and psychological recovery, to optimize the quality of life of children and families and to reduce costs [12]. In parallel with the increase in the number of patients in the pediatric age group, especially in home mechanical ventilation support, larger-scale analyzes and studies have begun to be conducted. However, in Turkey, only a limited number of studies have been performed with a limited series of patients. In this study, clinical features, long-term follow-up and factors affecting the prognosis of patients discharged home with tracheostomy support from our pediatric intensive care unit were evaluated retrospectively. Materials and Methods In this study, patients between one month and 18 years who underwent tracheostomy in Medeniyet University, Göztepe Training and Research Hospital, Pediatric Intensive Care Unit between May 2015 and June 2019 were evaluated retrospectively. Medeniyet University Göztepe Training and Research Hospital Ethics Committee approval was obtained (Decision No: 2019/0256) for this study. Age, sex, tracheostomy opening day, number of intensive care hospitalization days, underlying disease (s), follow-up period at home, HMV support status, parental education status, number of people living at home, the region of residence and survival data were recorded. Patients who underwent tracheostomy at the external center who died before being discharged home after tracheostomy was opened and patients who could not be followed up after discharge were excluded from this study. Training for the family members who will provide home care was provided by senior trained nurses in compliance with the “Intensive Care of Child at Home, Family Care at Home” training guide and form organized by our unit for standardization of education. At least two family members of each patient were included in the home care program. In training forms competency of the participants was provided concerning the issues, including aspiration, replacement of the tracheostomy cannula, nutrition education (oral/nasogastric/gastrostomy), approach to emergencies (tracheostomy blockage or displacement, equipment failure, oxygen saturation decrease, heart rate weakening), and use of home-type equipment (home-type mechanical ventilator) device, oxygen concentrator, rechargeable aspirator, pulse oximeter). The patients were transferred home by an ambulance, accompanied by a doctor. The phone numbers of the intensive care unit/physician were given in case the patients/ caregivers could get contact with if the patients might encounter any problem at home. The discharged patients were called for periodic controls according to the underlying disease and the patient s clinic. Statistical Analysis Statistical analysis of the data was performed by NCSS (Number Cruncher Statistical System) 2007 Statistical Software (Utah, USA). In addition to descriptive statistical methods (frequency and percentage distributions, median, interquartile range), independent t-test was used for comparison of pairs of normal distribution variables, MannWhitney U test for comparison of pairs without normal distribution, and chi-square test for comparison of qualitative data were used. P<0.05 was considered statistically significant for all results.