Bedside Tracheostomy on Pediatric ICU Subjects Supported by Extracorporeal Membrane Oxygenation.

Abstract

BACKGROUND:

Tracheostomy facilitates ambulatory extracorporeal membrane oxygenation (ECMO) as a bridge to recovery or lung transplantation in patients with respiratory failure, yet data on this procedure in this population are lacking. This report describes a series of pediatric ICU patients who had a bedside tracheostomy performed while being supported on ECMO and examines the potential impact of this procedure on active rehabilitation and sedation requirements.

METHODS:

This retrospective case series reviews all patients in the pediatric ICU who received a tracheostomy while being supported on ECMO at a single tertiary care center for the past 3 y. This descriptive report reviews the surgical procedure, anticoagulation management, adjustments to sedation, and complications.

RESULTS:

Nine subjects between January 2013 and December 2015 were identified for review. The subjects ranged in age from 7 y to 25 y. All tracheostomies were performed as bedside procedures in the pediatric ICU. All subjects but one were supported by venovenous ECMO. Surgical approaches included open tracheostomy (2 subjects, 22%), percutaneous tracheostomy (1 subject, 11%), and a hybrid approach (6 subjects, 67%). Anticoagulation was held for all subjects surrounding the procedure. Three subjects had superficial bleeding after the procedure, but only one required re-exploration of the surgical field. All subjects made substantial sedation weans within 72 h of tracheostomy. With these weans, subjects were better able to participate in rehabilitation. Five subjects (55.6%) ambulated on ECMO. The rate of survival to hospital discharge was 67%, and no deaths were related to the tracheostomy procedure.

CONCLUSIONS:

Bedside tracheostomy can feasibly be performed on pediatric patients being supported with ECMO as a way to improve mobility, promote ambulation, and decrease sedation. Timing and ideal surgical approach require further study to fully maximize benefits and minimize risks.

• Authors: Stephanie P Schwartz, Desiree Bonadonna, Matthew G Hartwig, Ira M Cheifetz
• Journal: Respiratory care (Respir Care) Vol. 62 Issue 11 Pg. 1447-1455 (Nov 2017) ISSN: 1943-3654 [Electronic] United States
• PMID: 28743722 (Publication Type: Evaluation Study, Journal Article)
• Copyright: Copyright © 2017 by Daedalus Enterprises.

Topics

• Adolescent
• Adult
• Child
• Extracorporeal Membrane Oxygenation (methods)
• Feasibility Studies
• Female
• Hemostasis, Surgical (methods)
• Humans
• Intensive Care Units, Pediatric
• Male
• Point-of-Care Systems
• Retrospective Studies
• Tracheostomy (methods)
• Treatment Outcome
• Young Adult