Outcomes of home mechanical ventilation with tracheostomy after congenital heart surgery

Abstract

Objective: After congenital heart surgery, some patients may need long-term mechanical ventilation because of chronic respiratory failure. In this study, we analysed outcomes of the patients who need tracheostomy and home mechanical ventilation. Methods: Amongst 1343 patients who underwent congenital heart surgery between January, 2014 and June, 2018, 45 needed tracheostomy and HMV. The median age of these patients was 6.4 months (12 days–6.5 years). Nineteen patients underwent palliation while 26 patients underwent total repair. Post-operative diaphragm plication was performed in five patients (11%). Median duration of mechanical ventilation before tracheostomy was 32 days (8–154 days). The patients were followed up with their home ventilators in ward and at home. Mean follow-up time was 36.24 ± 11.61 months. Results: The median duration of ICU stay after tracheostomy was 27 days (range 2–93 days). Follow-up time in ward was median 30 days (2–156 days). A total of 12 patients (26.6%) were separated from the ventilator and underwent decannulation during hospital stay. Thirty-two patients (71.1%) were discharged home with home ventilator support. Of them, 15 patients (46.9%) were separated from the respiratory support in median of 6 weeks (1 week–11 months) and decannulations were performed. Total mortality was 31.1%. in which four patients are still HMV dependent. There was no significant difference for decannulation between total repair and palliation patients. Conclusion: HMV via tracheostomy is a useful option for the treatment of children who are dependent on long-term ventilation after congenital heart surgery although there are potential risks.

Tracheostomy Timing During Pediatric Cardiac Intensive Care: Single Referral Center Retrospective Cohort

“…The high mortality to current follow-up and in-hospital mortality in our study are striking, though overall consistent with existing literature for pediatric patients with cardiac disease requiring tracheostomy (3–5, 15–23). In-hospital mortality for our cohort is 10-fold higher than in-hospital mortality for all CICU patients during the study period and substantially higher than reported mortality in general pediatric patients with tracheostomy (2, 6, 13, 33–35).…”

“…The key finding of our study was an association between a longer duration of pre-tracheostomy PPV and the hazard of mortality in children with cardiac disease when controlling for other factors. Seven prior studies have described tracheostomy timing relative to total duration of ventilation in pediatric patients including those with congenital heart disease (CHD) (4, 9, 16, 17, 19, 20, 22), but only two specifically compared outcomes based on timing of tracheostomy in children with heart disease (4, 22). A single-institution study of 17 cardiac patients (22) and a multicenter cohort of 126 patients with hypoplastic left heart syndrome (HLHS) (4) both failed to identify an association between duration of ventilation pre-tracheostomy and survival.…”

“…The frequency of tracheostomy in children with cardiac disease has, however, increased in recent years (2,4,5). Indications for tracheostomy for children with cardiac disease are often multifactorial, and long-term survival is as low as 50% (15)(16)(17)(18)(19)(20)(21)(22). Although studies describe the epidemiology of pediatric patients with cardiac disease undergoing tracheostomy, most are restricted to single-center studies with small cohorts, limited outcomes, specific cardiac diagnoses, or a few multicenter studies that lack longitudinal follow-up data (3)(4)(5)(15)(16)(17)(18)(19)(20)(21)(22)(23).…”

“…Indications for tracheostomy for children with cardiac disease are often multifactorial, and long-term survival is as low as 50% (15)(16)(17)(18)(19)(20)(21)(22). Although studies describe the epidemiology of pediatric patients with cardiac disease undergoing tracheostomy, most are restricted to single-center studies with small cohorts, limited outcomes, specific cardiac diagnoses, or a few multicenter studies that lack longitudinal follow-up data (3)(4)(5)(15)(16)(17)(18)(19)(20)(21)(22)(23). Although heterogeneous pediatric cohorts including cardiac patients show later tracheostomy to be associated with worse outcomes (9,13), two cardiac-specific cohorts did not identify an association between the timing of tracheostomy and mortality (4,22).…”

“…Tracheostomy use in pediatric patients with cardiac disease is unique from other pediatric conditions such as respiratory failure, upper airway obstruction (UAO), and neurologic injuries/trauma, with relatively lower use, higher mortality, and wide variation in timing (2–4, 9, 14–20). Differences in use are likely attributable to concerns for infectious risk or cardiopulmonary interactions, staged cardiac surgical procedures that might obviate the need for tracheostomy or hope for recovery (7).…”