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Use of tracheostomy in the PICU among patients requiring prolonged mechanical ventilation. Intensive Care Med 2014 Jun;40(6):863-70

Date

05/03/2014

Pubmed ID

24789618

DOI

10.1007/s00134-014-3298-4

Scopus ID

2-s2.0-84901478228   33 Citations

Abstract

PURPOSE: The purpose of the present study is to describe the use of tracheostomy, specifically frequency, timing (in relation to initiation of mechanical ventilation), and associated factors, in a large cohort of children admitted to North American pediatric intensive care units (PICUs) and requiring prolonged mechanical ventilation.

METHODS: This was a retrospective cohort study. De-identified data were obtained from the VPS(LLC) database, a multi-site, clinical PICU database. Admissions between 1 July 2009 and 30 June 2011 were enrolled in the study if the patient required mechanical ventilation for at least 72 h and did not have a tracheostomy tube at initiation of mechanical ventilation.

RESULTS: A total of 13,232 PICU admissions from 82 PICUs were analyzed in the study; of these, 872 (6.6 %) had a tracheostomy tube inserted after initiation of mechanical ventilation. The rate varied significantly (0-13.4 %, p < 0.001) among the 45 PICUs that had 100 or more admissions included in the study. The median time to insertion of a tracheostomy tube was 14.4 days (IQR 7.4-25.7), and it also varied significantly by unit (4.3-30.4 days, p < 0.001) among those that performed at least ten tracheostomies included in the study.

CONCLUSIONS: There is significant variation in both the frequency and time to tracheostomy between the studied PICUs for patients requiring prolonged mechanical ventilation; among those who received a tracheostomy, the majority did so after two or more weeks of mechanical ventilation. Future studies examining tracheostomy benefits, disadvantages, outcomes, and resource utilization of this patient subgroup are indicated.

Author List

Wakeham MK, Kuhn EM, Lee KJ, McCrory MC, Scanlon MC

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 Professor in the Pediatrics department at Medical College of Wisconsin




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

Child
Child, Preschool
Cohort Studies
Female
Hospitalization
Humans
Infant
Intensive Care Units, Pediatric
Male
Respiration, Artificial
Retrospective Studies
Tracheostomy