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Predictors of need for mechanical ventilation at discharge after tracheostomy in the PICU. Pediatr Pulmonol 2016 Jan;51(1):53-9 PMID: 25823590

Pubmed ID

25823590

DOI

10.1002/ppul.23195

Abstract

BACKGROUND: The objective of this study was to determine factors predictive of need for mechanical ventilation (MV) upon discharge from the pediatric intensive care unit (PICU) among patients who receive a tracheostomy during their stay.

METHODS: This was a retrospective cohort study using the Virtual PICU Systems (VPS) database. Patients <18 years old admitted between 2009-2011 who required MV for at least 3 days and received a tracheostomy during their PICU stay were included.

RESULTS: A total of 680 pediatric patients from 74 PICUs were included, of whom 347 (51%) remained on MV at the time of PICU discharge. Neonates (30/38, 79%) and infants (129/203, 64%) required MV at PICU discharge after tracheostomy more often than adolescents (66/141, 47%) and children (122/298, 41%). Time on MV pre-tracheostomy was longer among those who required MV at discharge (median 18.3 vs. 13.8 days, P < 0.0001); however, number of failed extubations was similar (median 1 for both groups, P = 0.97). On mixed-effects multivariable regression analysis, the age categories of neonate (OR 2.9, 95%CI 1.1-7.6, P = 0.03), and infant (OR 1.7, 95%CI 1.1-2.8, P = 0.03), and ventilator days prior to tracheostomy (OR 1.01, 95%CI 1.0-1.02, P = 0.01) were significantly associated with increased odds of MV upon PICU discharge, while being a trauma admission was associated with decreased odds (OR 0.45, 95%CI 0.28-0.73, P = 0.001).

CONCLUSIONS: Younger patients and those with prolonged courses of MV prior to tracheostomy are more likely to continue to need MV upon PICU discharge.

Author List

McCrory MC, Lee KJ, Scanlon MC, Wakeham MK

Authors

K Jane Lee MD Associate Professor in the Pediatrics department at Medical College of Wisconsin
Matthew C. Scanlon MD Professor in the Pediatrics department at Medical College of Wisconsin
Martin K. Wakeham MD Associate Professor in the Pediatrics department at Medical College of Wisconsin




Scopus

2-s2.0-84977473689

MESH terms used to index this publication - Major topics in bold

Adolescent
Child
Child, Preschool
Databases, Factual
Female
Hospitalization
Humans
Infant
Infant, Newborn
Intensive Care Units, Pediatric
Male
Patient Discharge
Predictive Value of Tests
Respiration, Artificial
Retrospective Studies
Tracheostomy
jenkins-FCD Prod-331 a335b1a6d1e9c32173c9534e6f6ff51494143916