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

Published

Journal Article

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.

Full Text

Duke Authors

Cited Authors

  • Schwartz, SP; Bonadonna, D; Hartwig, MG; Cheifetz, IM

Published Date

  • November 2017

Published In

Volume / Issue

  • 62 / 11

Start / End Page

  • 1447 - 1455

PubMed ID

  • 28743722

Pubmed Central ID

  • 28743722

Electronic International Standard Serial Number (EISSN)

  • 1943-3654

Digital Object Identifier (DOI)

  • 10.4187/respcare.05442

Language

  • eng

Conference Location

  • United States