Use of tracheostomy in the PICU among patients requiring prolonged mechanical ventilation

Area of Science:

• Pediatric Critical Care Medicine
• Respiratory Medicine
• Surgical Procedures

Background:

• Prolonged mechanical ventilation is common in pediatric intensive care units (PICUs).
• Tracheostomy is a procedure used to facilitate long-term airway management and mechanical ventilation.
• Understanding tracheostomy practices in critically ill children is crucial for optimizing care.

Purpose of the Study:

• To analyze the frequency and timing of tracheostomy in children requiring prolonged mechanical ventilation in North American PICUs.
• To identify factors associated with tracheostomy use in this patient population.

Main Methods:

• Retrospective cohort study utilizing de-identified data from the VPS(LLC) database.
• Included pediatric intensive care unit admissions requiring mechanical ventilation for at least 72 hours, without pre-existing tracheostomy.
• Data collected from July 2009 to June 2011 across 82 North American PICUs.

Main Results:

• A total of 13,232 admissions were analyzed; 6.6% (872 patients) received a tracheostomy after mechanical ventilation initiation.
• Tracheostomy rates varied significantly between PICUs (0-13.4%, p < 0.001).
• Median time to tracheostomy was 14.4 days, with significant unit-level variation (4.3-30.4 days, p < 0.001).

Conclusions:

• Significant variability exists in tracheostomy frequency and timing across PICUs for children on prolonged mechanical ventilation.
• The majority of tracheostomies were performed after two weeks of mechanical ventilation.
• Further research is warranted to evaluate the benefits, drawbacks, outcomes, and resource utilization of tracheostomy in this specific patient group.