2.5 Management of congenital tracheal stenosis
The open-PICU group was managed perioperatively by pediatric and cardiovascular surgeons, whereas the closed-PICU group was managed by pediatric intensivists. In addition to this major change in management, the following measures were taken by the pediatric intensivists in the closed-PICU group: (1) interdisciplinary conferences were held every morning to discuss any multispecialty issues; (2) daily levels of sedation and other aspects of patient care were shared at the patients’ bedside with the nurse and intensivists in charge; (3) Intraoperative respiratory and circulation management problems during surgery and anesthesia were shared with intensive care using a standardized format; (4) resuscitation and ECMO trouble-shooting simulations were conducted regularly with nurses and medical technicians, and the team was educated not only in maintaining and managing emergency equipment but also in responding to emergency situations; (5) early rehabilitation involving respiratory physical therapy such as prevention of atelectasis and body positioning by physical therapists was initiated in the PICU on the day after the surgery; and (6) pediatric intensivists installed devices such as high-flow nasal cannula and non-invasive positive pressure, which were used expeditiously after extubation. In the open-PICU group, regular conferences were not held, anesthesiologists were not involved in sedation, and no sedation scale was used. ECMO simulation was mainly related to the initiation and instrumentation of ECMO by cardiovascular surgeons and nurses. It was not based on the resuscitation algorithms.