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.