Prodhan Parthak, Agarwal Amit, ElHassan Nahed O, Bolin Elijah H, Beam Brandon, Garcia Xiomara, Gaies Michael, Tang Xinyu
Pediatric Cardiology, University of Arkansas for Medical Sciences, Arkansas Children's Hospital, Little Rock, Arkansas; Pediatric Critical Care, University of Arkansas for Medical Sciences, Arkansas Children's Hospital, Little Rock, Arkansas.
Pulmonary Medicine, University of Arkansas for Medical Sciences, Arkansas Children's Hospital, Little Rock, Arkansas.
Ann Thorac Surg. 2017 Apr;103(4):1308-1314. doi: 10.1016/j.athoracsur.2016.09.016. Epub 2016 Nov 16.
Less than 2.7% of infants undergoing congenital heart disease operations have difficulty weaning from invasive mechanical ventilation. In such instances, clinicians may choose to perform tracheostomy. Limited literature has examined tracheostomy placement specifically in infants with hypoplastic left heart syndrome (HLHS). This study evaluated the risk factors for tracheostomy placement in infants with HLHS and examined the outcomes of these infants before their first hospital discharge.
This retrospective analysis of the Pediatric Heath Information System data set included infants with HLHS who underwent stage 1 Norwood operation, a hybrid procedure, or heart transplant from 2004 through 2013.
We identified 5721 infants with HLHS, and 126 underwent tracheostomy placement. Infants in the tracheostomy group had more morbidities and a higher mortality rate across the study period. Diagnosis of chromosomal abnormalities, anomalies of the trachea and esophagus, larynx, diaphragm and nervous system, bilateral vocal cord paralysis, and necrotizing enterocolitis, and procedures including extracorporeal membrane oxygenation support, cardiac catheterization, and gastrostomy tube were independently associated with tracheostomy placement in the study population. Despite an overall increase in rates of tracheostomy performed in infants with HLHS during the study period, the mortality rate did not improve among tracheostomy patients.
Several risk factors were identified in infants with HLHS in whom a tracheostomy was placed during their first hospitalization. Despite an overall increase in rates of tracheostomies during the study period, the mortality rate did not improve among these patients. Appropriate family counseling and thorough preoperative case selection is suggested when discussing possible tracheostomy placement in infants with HLHS.
接受先天性心脏病手术的婴儿中，不到2.7%在脱离有创机械通气时存在困难。在这种情况下，临床医生可能会选择进行气管造口术。专门针对左心发育不全综合征（HLHS）婴儿进行气管造口术的文献有限。本研究评估了HLHS婴儿进行气管造口术的风险因素，并检查了这些婴儿首次出院前的结局。
这项对儿科健康信息系统数据集的回顾性分析纳入了2004年至2013年期间接受一期诺伍德手术、杂交手术或心脏移植的HLHS婴儿。
我们识别出5721例HLHS婴儿，其中126例接受了气管造口术。在整个研究期间，气管造口术组的婴儿有更多的疾病和更高的死亡率。染色体异常、气管和食管、喉、膈肌及神经系统异常、双侧声带麻痹和坏死性小肠结肠炎的诊断，以及包括体外膜肺氧合支持、心导管检查和胃造瘘管置入等操作，在研究人群中与气管造口术的实施独立相关。尽管在研究期间HLHS婴儿进行气管造口术的比例总体有所增加，但气管造口术患者的死亡率并未改善。
在首次住院期间接受气管造口术的HLHS婴儿中识别出了几种风险因素。尽管在研究期间气管造口术的比例总体有所增加，但这些患者的死亡率并未改善。在讨论HLHS婴儿可能的气管造口术时，建议进行适当的家庭咨询和全面的术前病例选择。
