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.