Elective tracheostomy in mechanically ventilated children in Canada

Area of Science:

• Pediatric Critical Care Medicine
• Respiratory Management
• Surgical Procedures in Children

Background:

• Prolonged mechanical ventilation in children often necessitates airway management strategies.
• Tracheostomy is a potential intervention for long-term respiratory support in critically ill pediatric patients.
• Understanding current practices and physician opinions is crucial for optimizing care.

Purpose of the Study:

• To assess the current practices and opinions of Canadian pediatric intensivists regarding tracheostomy.
• To investigate the utilization of tracheostomy in children requiring prolonged mechanical ventilation for potentially reversible conditions.

Main Methods:

• A self-administered survey was distributed to pediatric intensivists across Canada.
• Data were collected from physicians in pediatric critical care units (PCCUs).
• Response rate was 81% (63 physicians) across all 16 participating PCCUs.

Main Results:

• Tracheostomy rates were low (<1.5%), with most centers performing 1-5 procedures annually.
• Percutaneous tracheostomy was used in only 19% of centers.
• Physician willingness to perform tracheostomy varied by diagnosis (e.g., TBI vs. ARDS) but not by age.
• 81% believed risks did not outweigh benefits, and 51% felt tracheostomy was underutilized.

Conclusions:

• Elective tracheostomy is infrequently performed in Canadian pediatric critical care.
• A significant proportion of pediatric intensivists perceive tracheostomy as underutilized.
• Further research is warranted to explore the role and optimal techniques for pediatric tracheostomy.