Abstract
Perioperative management of congenital tracheal stenosis (CTS) is
challenging.
Objectives: We
investigated the effect of closed-pediatric intensive care unit (PICU)
perioperative management by pediatric intensivists, compared with
open-PICU management by surgeons, on the ventilator-free days (VFD) and
length of postoperative PICU stay in children with CTS.
Methods: This retrospective cohort study was conducted in a
PICU in Japan. Children with CTS who underwent slide tracheoplasty were
grouped according to whether they were perioperatively managed in an
open (January 2015 to April 2016) or a closed (May 2016 to July 2019)
PICU. Data were extracted from patient medical records.
Results: In total, 13 and 38 patients were included in the
open- and closed-PICU groups, respectively. Compared to the open-PICU
group, the closed-PICU group had shorter durations of muscle relaxant
administration (median: 4 vs. 5 days; P < 0.001);
earlier initiation of enteral feeding (median: postoperative day 1 vs.
postoperative day 7; P < 0.001); more 28-day VFD
(median: 21 vs. 20 days; P = 0.04); and shorter duration of
postoperative PICU stay (median: 16 vs. 36 days; P = 0.002), but
the mortality did not differ significantly (0/38 [0%] vs. 1/13
[8%]; P = 0.25).
Conclusions: Closed-PICU perioperative management with
pediatric intensivists’ participation significantly increased 28-day VFD
and reduced the length of postoperative PICU stay in patients with CTS.
Keywords: pediatric intensive care units; tracheal stenosis;
perioperative care; surgical intensive care