1. Introduction
Congenital tracheal stenosis (CTS) is a rare disease that affects 1 in
64,500 births1. It is characterized by the presence of
complete tracheal rings, which can lead to narrowing of the
airway1. Its clinical findings vary depending on the
length and diameter of CTS. The disease may be fatal in some cases and
is often exacerbated during infancy when developmental activity is
increased, thereby requiring surgical treatment. CTS is associated with
cardiovascular malformations in 80% of cases1.
Therefore, perioperative management requires close monitoring of
respiration and circulation, and careful management in the pediatric
intensive care unit (PICU) is required.
The surgical strategy for CTS varies depending on tracheal morphology,
clinical symptoms, and the presence of cardiac
complications2. Decision-making regarding the
performance of simultaneous and staged tracheal and cardiac surgery is
crucial3 (Figure 1). Therefore, a collaboration of
multiple departments, including cardiovascular and pediatric surgery, is
warranted. Slide tracheoplasty is performed with the assistance of
cardiopulmonary bypass (CPB), followed by PICU-based management for
several days or weeks. Continuous muscle relaxants are prescribed
postoperatively for several days to prevent excessive stress on the
anastomosis.
In adults, A high-intensity intensive care unit (ICU), managed by
intensivists on a daily basis, has been recommended (Grade
1B)4 and has been shown to increase patient survival,
reduce length of ICU stay5, and decrease mortality in
special disease groups such as those admitted to adult cardiac
ICUs6. Moreover, PICU management by pediatric
intensivists has been shown to reduce mortality, duration of mechanical
ventilation, length of PICU stay, and hospital-acquired
infections7.
Perioperative management of CTS at the Hyogo Prefectural Kobe Children’s
Hospital (hereafter referred to as “our hospital”), before May 2016,
was performed by pediatric and cardiovascular surgeons because there
were no pediatric intensivists employed by our hospital. Since the
establishment of the new PICU in May 2016, the open-PICU management
system in our hospital became a closed one, with pediatric intensivists
present on-site 24 hours a day. This changed the perioperative
management of patients with CTS.
In this study, we investigated the hypothesis that closed-PICU
management by pediatric intensivists improved the outcomes of patients
with CTS.