PT  - JOURNAL ARTICLE
AU  - Schwartz, Stephanie P
AU  - Bonadonna, Desiree
AU  - Hartwig, Matthew G
AU  - Cheifetz, Ira M
TI  - Bedside Tracheostomy on Pediatric ICU Subjects Supported by Extracorporeal Membrane Oxygenation
AID  - 10.4187/respcare.05442
DP  - 2017 Nov 01
TA  - Respiratory Care
PG  - 1447--1455
VI  - 62
IP  - 11
4099  - http://rc.rcjournal.com/content/62/11/1447.short
4100  - http://rc.rcjournal.com/content/62/11/1447.full
AB  - 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.