CC BY-NC-ND 4.0 · Journal of Cardiac Critical Care TSS
DOI: 10.1055/s-0041-1723749
Original Article

Tracheostomy in Postoperative Pediatric Cardiac Surgical Patients—The Earlier, the Better

Chalattil Bipin
1  Intensive Care for Cardio Thoracic Vascular Surgery, Cardio Neuro Center, All India Institute of Medical Sciences, New Delhi, India
,
Manoj K. Sahu
1  Intensive Care for Cardio Thoracic Vascular Surgery, Cardio Neuro Center, All India Institute of Medical Sciences, New Delhi, India
,
Sarvesh P. Singh
1  Intensive Care for Cardio Thoracic Vascular Surgery, Cardio Neuro Center, All India Institute of Medical Sciences, New Delhi, India
,
Velayoudam Devagourou
1  Intensive Care for Cardio Thoracic Vascular Surgery, Cardio Neuro Center, All India Institute of Medical Sciences, New Delhi, India
,
Palleti Rajashekar
1  Intensive Care for Cardio Thoracic Vascular Surgery, Cardio Neuro Center, All India Institute of Medical Sciences, New Delhi, India
,
Milind P. Hote
1  Intensive Care for Cardio Thoracic Vascular Surgery, Cardio Neuro Center, All India Institute of Medical Sciences, New Delhi, India
,
Sachin Talwar
1  Intensive Care for Cardio Thoracic Vascular Surgery, Cardio Neuro Center, All India Institute of Medical Sciences, New Delhi, India
,
Shiv K. Choudhary
1  Intensive Care for Cardio Thoracic Vascular Surgery, Cardio Neuro Center, All India Institute of Medical Sciences, New Delhi, India
› Author Affiliations
Funding None.

Abstract

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 hospital stay (p = 0.0016), sepsis (p = 0.03), high risk surgery (p = 0.04), postoperative sepsis (p = 0.001), C-reactive protein (p = 0.04), ventilator-associated pneumonia (VAP; p = 0.006), antibiotic escalation (p = 0.006), and antifungal therapy (p = 0.01) requirement. Furthermore, ET was associated with lesser duration of mechanical ventilation (p = 0.0027), length of ICU stay (LOICUS; p = 0.01), length of hospital stay (LOHS; p = 0.001), lesser days of feed interruption (p = 0.0017), and tracheostomy tube change (p = 0.02). ET group of children, who had higher total ventilation-free days (p = 0.02), were decannulated earlier (p = 0.03) and discharged earlier (p = 0.0089).

Conclusion ET had significant benefits in reduction of postoperative morbidities with overall shorter mechanical ventilation, LOICUS, and LOHS, better nutrition supplementation, lesser infection, etc. These benefits may promote faster patient convalescence and rehabilitation with reduced hospital costs.



Publication History

Publication Date:
08 March 2021 (online)

© 2020. Official Publication of The Simulation Society TSS, accredited by International Society of Cardiovascular Ultrasound ISCU. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial-License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/.)

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