12 Yýllýk Süreçte 37 Çocukta Trakeostomi Tecrübelerimiz: Retrospektif Çalýþma

GÝRÝÞ ve AMAÇ: Çocuklarda trakeotomi için en önemli endikasyon kardiyopulmoner ve nörolojik hastalýklar nedeniyle uzun süreli entübasyondur. Pediatrik trakeostomi %10 ile %58 arasýnda deðiþen bir komplikasyon oraný ve %0 ile %3,6 arasýnda deðiþen bir ölüm oraný ortaya koymaktadýr. 12 yýllýk trakeostomi deneyimlerimizi anlatmayý amaçladýk.
YÖNTEM ve GEREÇLER: Bu çalýþma, Türkiye’de Çocuk Cerrahisi Kliniðimizde 2009-2021 yýllarý arasýnda trakeostomi uygulanan çocuk hastalarýn týbbi kayýtlarýnýn retrospektif olarak incelenmesidir.
BULGULAR: Bölümümüzde 12 yýl boyunca 37 çocuða trakeostomi açýldý. 17’si erkek (%45.9), 20’si kadýn (%54.1) idi. Ortanca trakeostomi yaþý 5 aylýktý (min: 2ay-maks: 14yýl). Acil trakeostomi 8’inde (%21,6), planlanan trakeostomi 29’unda (%78,4) yapýldý. Ameliyat sýrasýnda ve ame-liyat sonrasý erken günlerde 34 hastada (%91,9) herhangi bir sorun yaþanmadý, trakeal atrezili 2 yenidoðan (%5,4) birinci ve ikinci günlerde kaybedildi. Bir hastada pansuman sýrasýnda kanülün yanlýþ yerleþtirilmesi nedeniyle desatüre (%2.7) oldu, kanül entübasyondan sonra tekrar güvenli bir þekilde yerleþtirildi. Trakeostomi komplikasyonlarý olarak 2-kanül çýkmasý, 1-granülasyon, 2-kanül oklüzyonu (biri postoperatif 2.günde ve diðeri ise postoperatif 10.günde) görüldü. 23 olgu (%62.2) hayatta kaldý, 14 olgu (%37.8) kaybedildi. Hayatta kalan hastalardan 3 yýl sonra KDH’li bir erkek çocukta ve EA+Distal TEF+Þiddetli Trakeomalazi+Fallot Tetralojisi olan bir kýz çocuðunda iki trakeostomi kapatýldý.
TARTIÞMA ve SONUÇ: Pediatrik trakeotomi, uygun cerrahi teknik ve yeterli postoperatif bakým ile minimal komplikasyon oranlarý ile baþarýyla gerçekleþtirilebilir.

Tracheostomy Experiences in 37 Children during 12 Years: A Retrospective Study

INTRODUCTION: The most important indication for tracheotomy in children is long-term intubation due to cardiopulmonary and neurological diseases. Pediatric tracheostomy is associated with varying complication (10–58%) and mortality (0–3.6%) rates. Herein, we aimed to pres-ent the results of our 12 years of pediatric tracheostomy experience.
METHODS: This was a retrospective study of medical records of pediatric patients who underwent tracheostomy in our pediatric surgery department from 2009 to 2021.
RESULTS: During 12 years, 37 tracheostomies were performed in 17 (45.9%) males and 20 (54.1%) female children, and the median age was 5 months (min: 2 months–14 years). Emergency tracheostomy was performed in 8 (21.6%), while planned tracheostomy in 29 (78.4%). During the operation and early postoperative days, any medical problem was detected in 34 (91.9%) patients, while 2 (5.4%) neonates with tracheal atresia were lost in the first and second postoperative days. One patient was desaturated (2.7%) due to decannulation during the tracheostomy dressing; however, tracheostomy cannula was safely inserted again after intratracheal intubation. Two cannulas were removed; granulation tissue was formed in 1 case, and occlusion of the cannula was observed in 2 cases (one on the post-operative 2nd day, and the second one on the post-operative 10th day) as complications of tracheostomy. Twenty-three patients (62.2%) survived, and 14 (37.8%) patients died. Among the surviving patients, two tracheostomies were closed in a boy (with congenital diaphragmatic hernia), and in a girl (with esophageal atresia, distal tracheoesophageal fistula, severe tracheomalacia, and Fallot tetralogy), 3 years postoperatively.
DISCUSSION AND CONCLUSION: Pediatric tracheotomy can be successfully performed with minimal complication rates through appropriate surgical technique and adequate postoperative care.