Çocuk Trakeostomi: Endikasyonlar, Komplikasyonlar ve 20 Olgunun İncelenmesi
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Date
2014
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İnönü Üniversitesi Tıp Fakültesi Dergisi
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Abstract
Amaç: Çocuklarda trakeotomi önceleri en sık akut hava yolu enfeksiyonu nedeni ile yapılırdı. Endikasyonlar daha öncekidönemlere göre
değişmektedir; şu an konjenital malformasyonlar ve uzun sureli entübasyon için yapılan trakeotomi sıklığı daha fazladır. Günümüzde
pediatrik olgularda trakeostomi endikasyonları ve sonuçları hakkında henüz bir uzlaşma oluşmamıştır. Bu çalışmanın amacı konuyla ilgili
deneyimlerimizi ve literatürü beraber ortaya koymaktır.
Gereç ve Yöntemler: Bu çalışmada Ekim 2010-Ocak 2013 tarihleri arasında kulak burun boğaz ve pediatri kliniğimizde uzun sureli
entübasyon ve solunum problemi nedeni ile trakeotomi açılan 20 hasta değerlendirilmiştir. Hastaların yaşları, cinsiyetleri, entübe kaldıkları
süre, endikasyonları, komplikasyonları ve hastaların son durumu kaydedilmiştir.
Bulgular: 20 seçilmiş olguya trakeotomi işlemi yapılmıştır. Hastaların tümü ortalama 100 gün (0-585 gün) takip edilmişlerdir. Dokuz olgu
takip süresince primer hastalıkları nedeniyle eksitus olmuştur. Ölümlerin hepsi ilk 30 günden sonra olmuştur(42.9%). Hiçbir hastanın
trakeotomisi ağız solunumuna geçemediği için kapatılmamıştır. Komplikasyonlar: Serimizde bir olguda steroid tedavisi gerektirecek
suprastomal granülasyon dokusu, 1 olguda kazara dekanülasyon ortaya çıkmıştır. Toplam minör komplikasyon %10, majör
komplikasyonumuz olmamıştır.
Sonuç: Pediatrik olgulardaki uzamış entübasyon durumunda trakeostomi oldukça güvenli alternatif bir yaklaşımdır ve uzamış entübasyon
beklentisi olan olgularda güvenle ve zaman kaybetmeden uygulanabilir. Trakeostomi genel anestezi gerektirmeyen, gereğinde yatak
başında da kolayca uygulanabilen, düşük morbidite ve mortalite oranları olan bir işlemdir.
Objectives: Tracheotomy in its earlier days was most Commonly performed for acute airway infection in children. Its indications are now changing; it is now most commonly performed for congenital malformations and prolonged intubation. There is still no consensus about the indications and results of tracheostomy in children. The aim of this study was to determine our experience and review the literature. Material and Methods: In this study, we evaluated 20 patients in our department who would be unable to perform breathing prolonged intubation for tracheostomy between October 2010 and January 2013 retrospectively. Ages, genders, duration of intubation , indications, complications and current situation of the patient’s was enrolled. Results: Tracheostomy procedure was performed on 20 selected patients. All patients were followed for a median of 100 days (0-585 days). Nine of the patients died as a result of primary pathologies. All patients died after the first 30 days (42.9%). None of the patients gained their oral breathing ability back and therefore tracheostomy set was not removed. Complications: One of the patients had suprastemal granulotion tissue which needed steroid therapy and one had accidental decannulation. Our overall minor complication rate was 10%, and no major complication. Conclusion: Tracheostomy in pediatric cases in whom entubation time gets longer is a safe alternative approach and can be applied safely and without spending extra time in cases with expected long intubation time. Tracheostomy is a procedure requiring no general anesthesia, which can be easily performed at the bedside, and has low morbidity and mortality rates.
Objectives: Tracheotomy in its earlier days was most Commonly performed for acute airway infection in children. Its indications are now changing; it is now most commonly performed for congenital malformations and prolonged intubation. There is still no consensus about the indications and results of tracheostomy in children. The aim of this study was to determine our experience and review the literature. Material and Methods: In this study, we evaluated 20 patients in our department who would be unable to perform breathing prolonged intubation for tracheostomy between October 2010 and January 2013 retrospectively. Ages, genders, duration of intubation , indications, complications and current situation of the patient’s was enrolled. Results: Tracheostomy procedure was performed on 20 selected patients. All patients were followed for a median of 100 days (0-585 days). Nine of the patients died as a result of primary pathologies. All patients died after the first 30 days (42.9%). None of the patients gained their oral breathing ability back and therefore tracheostomy set was not removed. Complications: One of the patients had suprastemal granulotion tissue which needed steroid therapy and one had accidental decannulation. Our overall minor complication rate was 10%, and no major complication. Conclusion: Tracheostomy in pediatric cases in whom entubation time gets longer is a safe alternative approach and can be applied safely and without spending extra time in cases with expected long intubation time. Tracheostomy is a procedure requiring no general anesthesia, which can be easily performed at the bedside, and has low morbidity and mortality rates.
Description
İnönü Üniversitesi Tıp Fakültesi Dergisi, 2014.
Keywords
Pediatric Tracheostomy, Indications, Complications, Çocuk Trakeostomi, Endikasyonlar, Komplikasyon
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Citation
Baran Acar, Mehtap Acar, Erdem Yıldız, Rıza Murat Karaşen.(2014). Açık Dergisi Sistemleri (ADS) İnönü Üniversitesi Tıp Fakültesi Dergisi.2014;21(1):41-3
