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

Publication ,  Journal Article
Schwartz, SP; Bonadonna, D; Hartwig, MG; Cheifetz, IM
Published in: Respir Care
November 2017

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.

Duke Scholars

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Published In

Respir Care

DOI

EISSN

1943-3654

Publication Date

November 2017

Volume

62

Issue

11

Start / End Page

1447 / 1455

Location

United States

Related Subject Headings

  • Young Adult
  • Treatment Outcome
  • Tracheostomy
  • Retrospective Studies
  • Respiratory System
  • Point-of-Care Systems
  • Male
  • Intensive Care Units, Pediatric
  • Humans
  • Hemostasis, Surgical
 

Citation

APA
Chicago
ICMJE
MLA
NLM
Schwartz, S. P., Bonadonna, D., Hartwig, M. G., & Cheifetz, I. M. (2017). Bedside Tracheostomy on Pediatric ICU Subjects Supported by Extracorporeal Membrane Oxygenation. Respir Care, 62(11), 1447–1455. https://doi.org/10.4187/respcare.05442
Schwartz, Stephanie P., Desiree Bonadonna, Matthew G. Hartwig, and Ira M. Cheifetz. “Bedside Tracheostomy on Pediatric ICU Subjects Supported by Extracorporeal Membrane Oxygenation.Respir Care 62, no. 11 (November 2017): 1447–55. https://doi.org/10.4187/respcare.05442.
Schwartz SP, Bonadonna D, Hartwig MG, Cheifetz IM. Bedside Tracheostomy on Pediatric ICU Subjects Supported by Extracorporeal Membrane Oxygenation. Respir Care. 2017 Nov;62(11):1447–55.
Schwartz, Stephanie P., et al. “Bedside Tracheostomy on Pediatric ICU Subjects Supported by Extracorporeal Membrane Oxygenation.Respir Care, vol. 62, no. 11, Nov. 2017, pp. 1447–55. Pubmed, doi:10.4187/respcare.05442.
Schwartz SP, Bonadonna D, Hartwig MG, Cheifetz IM. Bedside Tracheostomy on Pediatric ICU Subjects Supported by Extracorporeal Membrane Oxygenation. Respir Care. 2017 Nov;62(11):1447–1455.

Published In

Respir Care

DOI

EISSN

1943-3654

Publication Date

November 2017

Volume

62

Issue

11

Start / End Page

1447 / 1455

Location

United States

Related Subject Headings

  • Young Adult
  • Treatment Outcome
  • Tracheostomy
  • Retrospective Studies
  • Respiratory System
  • Point-of-Care Systems
  • Male
  • Intensive Care Units, Pediatric
  • Humans
  • Hemostasis, Surgical