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Tracheostomy in Postoperative Pediatric Cardiac Surgical Patients—The Earlier, the BetterFunding None.
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.
Keywordspediatric cardiac surgery - intensive care - tracheostomy - prolonged mechanical ventilation
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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- 1 Mastropietro CW, Benneyworth BD, Turrentine M. et al. Tracheostomy after operations for congenital heart disease: an analysis of the society of thoracic surgeons congenital heart surgery database. Ann Thorac Surg 2016; 101 (06) 2285-2292
- 2 Armstrong PA, McCarthy MC, Peoples JB. Reduced use of resources by early tracheostomy in ventilator-dependent patients with blunt trauma. Surgery 1998; 124 (04) 763-766, discussion 766–767
- 3 Combes A, Luyt CE, Nieszkowska A, Trouillet JL, Gibert C, Chastre J. Is tracheostomy associated with better outcomes for patients requiring long-term mechanical ventilation?. Crit Care Med 2007; 35 (03) 802-807
- 4 Rodriguez JL, Steinberg SM, Luchetti FA, Gibbons KJ, Taheri PA, Flint LM. Early tracheostomy for primary airway management in the surgical critical care setting. Surgery 1990; 108 (04) 655-659
- 5 MacIntyre NR, Cook DJ, Ely Jr EW. et al. American College of Chest Physicians, American Association for Respiratory Care, American College of Critical Care Medicine. Evidence-based guidelines for weaning and discontinuing ventilatory support: a collective task force facilitated by the American College of Chest Physicians; the American Association for Respiratory Care; and the American College of Critical Care Medicine. Chest 2001; 120 (Suppl. 06) 375S-395S
- 6 Gupta S, Dixit S, Choudhry D. et al. Tracheostomy in adult intensive care unit: an ISCCM expert panel practice recommendation. Indian J Crit Care Med 2020; 24 (Suppl. 01) S31-S42
- 7 MacIntyre NR, Epstein SK, Carson S, Scheinhorn D, Christopher K, Muldoon S. National Association for Medical Direction of Respiratory Care. Management of patients requiring prolonged mechanical ventilation: report of a NAMDRC consensus conference. Chest 2005; 128 (06) 3937-3954
- 8 Rahmanian PB, Adams DH, Castillo JG, Chikwe J, Filsoufi F. Tracheostomy is not a risk factor for deep sternal wound infection after cardiac surgery. Ann Thorac Surg 2007; 84 (06) 1984-1991
- 9 Wouters R, Wellens F, Vanermen H, De Geest R, Degrieck I, De Meerleer F. Sternitis and mediastinitis after coronary artery bypass grafting. Analysis of risk factors. Tex Heart Inst J 1994; 21 (03) 183-188
- 10 Peinado DMC, Bedrinana JIC. Comparison of NCHS-1977, CDC-2000 and WHO-2006 Nutritional Classification in 32 to 60 month-old Children in the Central Highlands of Peru (1992-2007).. Univers J Public Health 2013; 1 (03) 143-149
- 11 Kasiske B, Eckardt K. Kidney disease: improving global outcomes (KDIGO) acute kidney injury work group. KDIGO clinical practice guideline for acute kidney injury. Kidney inter. Suppl. 2012; 2: 1-138
- 12 Singer M, Deutschman CS, Seymour CW. et al. The third international consensus definitions for sepsis and septic shock (Sepsis-3). JAMA 2016; 315 (08) 801-810
- 13 Centers for Disease Control and Prevention/National Healthcare Safety Network. CDC/NHSN surveillance definitions for specific types of infections. Available at: https://www.cdc.gov/nhsn/pdfs/pscmanual/2020pscnosinfdef_current.pdf. Accessed January 15, 2021
- 14 Griffiths J, Barber VS, Morgan L, Young JD. Systematic review and meta-analysis of studies of the timing of tracheostomy in adult patients undergoing artificial ventilation. BMJ 2005; 330 (7502) 1243
- 15 Huang H, Li Y, Ariani F, Chen X, Lin J. Timing of tracheostomy in critically ill patients: a meta-analysis. PLoS One 2014; 9 (03) e92981
- 16 Young D, Harrison DA, Cuthbertson BH, Rowan K. TracMan Collaborators. Effect of early vs late tracheostomy placement on survival in patients receiving mechanical ventilation: the TracMan randomized trial. JAMA 2013; 309 (20) 2121-2129
- 17 Trouillet JL, Luyt CE, Guiguet M. et al. Early percutaneous tracheotomy versus prolonged intubation of mechanically ventilated patients after cardiac surgery: a randomized trial. Ann Intern Med 2011; 154 (06) 373-383
- 18 Rumbak MJ, Newton M, Truncale T, Schwartz SW, Adams JW, Hazard PB. A prospective, randomized, study comparing early percutaneous dilational tracheotomy to prolonged translaryngeal intubation (delayed tracheotomy) in critically ill medical patients. Crit Care Med 2004; 32 (08) 1689-1694
- 19 Scales DC, Thiruchelvam D, Kiss A, Redelmeier DA. The effect of tracheostomy timing during critical illness on long-term survival. Crit Care Med 2008; 36 (09) 2547-2557
- 20 Shaw JJ, Santry HP. Who gets early tracheostomy?: evidence of unequal treatment at 185 academic medical centers. Chest 2015; 148 (05) 1242-1250
- 21 Yavas S, Yagar S, Mavioglu L. et al. Tracheostomy: how and when should it be done in cardiovascular surgery ICU?. J Card Surg 2009; 24 (01) 11-18
- 22 Devarajan J, Vydyanathan A, Xu M. et al. Early tracheostomy is associated with improved outcomes in patients who require prolonged mechanical ventilation after cardiac surgery. J Am Coll Surg 2012; 214 (06) 1008-16.e4
- 23 Hosseinian L, Chiang Y, Itagaki S, Polanco A, Rhee A, Chikwe J. Earlier versus later tracheostomy in patients with respiratory failure after cardiac surgery in the United States. J Cardiothorac Vasc Anesth 2014; 28 (03) 488-492
- 24 Conforti A, Valfrè L, Scuglia M. et al. Laryngotracheal abnormalities in esophageal atresia patients: a hidden entity. Front Pediatr 2018; 6: 401
- 25 Alali AS, Scales DC, Fowler RA. et al. Tracheostomy timing in traumatic brain injury: a propensity-matched cohort study. J Trauma Acute Care Surg 2014; 76 (01) 70-76, discussion 76–78
- 26 Babu A, Madhavan K, Singhal M, Sagar S, Ranjan P. Pressure ulcer surveillance in neurotrauma patients at a level one trauma centre in India. Oman Med J 2015; 30 (06) 441-446
- 27 Ben-Avi R, Ben-Nun A, Levin S. et al. Tracheostomy after cardiac surgery: timing of tracheostomy as a risk factor for mortality. J Cardiothorac Vasc Anesth 2014; 28 (03) 493-496