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Updated: Aug 12, 2026
Guidelines for Elective Pediatric Fiberoptic Intubation
Published on: January 18, 2011
Early versus late tracheostomy in pediatric intensive care unit: does it matter? A 6-year experience
Alessandro Pizza1, Enzo Picconi2, Marco Piastra1
1Pediatric Intensive Care Unit, Department of Anesthesiology and Intensive Care, Sacro Cuore Catholic University, Rome, Italy.
Insights
Early tracheostomy in children significantly reduces ventilator-associated pneumonia (VAP) and shortens Pediatric Intensive Care Unit (PICU) stays. This timing may improve outcomes but requires further research for specific patient groups.
Area of Science:
- Pediatric Critical Care Medicine
- Respiratory Management
- Clinical Outcomes Research
Background:
- Tracheostomy timing in pediatric intensive care is not standardized.
- Ventilator-associated pneumonia (VAP) is a significant concern in mechanically ventilated children.
- Understanding the impact of tracheostomy timing on VAP and length of stay is crucial.
Purpose of the Study:
- To examine the relationship between tracheostomy timing, Pediatric Intensive Care Unit (PICU) length of stay, and ventilator-associated pneumonia (VAP) in children.
- To compare clinical outcomes between early and late tracheostomy groups.
Main Methods:
- Retrospective cohort study of pediatric patients undergoing tracheostomy over six years.
- Data collected included PICU length of stay, ventilation duration, VAP occurrence, and decannulation.
- Early tracheostomy defined as <=10 days of ventilation; late tracheostomy as >10 days.
Main Results:
- Early tracheostomy was associated with a significant decrease in VAP incidence compared to late tracheostomy (P=0.004).
- No significant differences observed in decannulation rates, long-term ventilation needs, or mortality.
- Early tracheostomy patients who were decannulated within 18 months showed reduced mechanical ventilation days and PICU stay.
Conclusions:
- Early tracheostomy may reduce VAP and shorten hospitalization and ventilation duration in pediatric intensive care.
- Further research is needed to identify specific pediatric patient populations that benefit most from early tracheostomy.
- Standardized guidelines for tracheostomy timing in pediatric patients are still lacking.
Background:
The aim of this study is to examine the clinical data of children who underwent tracheostomy during their stay in Pediatric Intensive Care Unit (PICU), in order to describe the relationship between the timing of tracheostomy, the length of PICU stay and the occurrence of ventilator-associated pneumonia (VAP).
Methods:
This is a retrospective cohort study that collects all patients undergoing tracheostomy during their PICU stay over a six-year period. Data collection included PICU length of stay, days of intubation, days of mechanical ventilation, primary indication for tracheostomy, information about VAP and decannulations. The early tracheostomy group was defined as patients who had ten or fewer days of continuous ventilation, whereas the late tracheostomy group had more than ten days of continuous ventilation.
Results:
A significant decrease in the rate of VAP incidence was noticed in the early tracheostomy group vs. late group (P=0.004, OR=0.39, 95% CI: 0.18-0.85). No differences were observed about decannulation, need of long-term ventilation and death rate. Significant decreases of days of mechanical ventilation and PICU stay were found in subgroup of patients who underwent early tracheostomy and were decannulated within 18 months.
Conclusions:
No standard timing for tracheostomy placement has been established in the pediatric population. Early tracheostomy can shorten the days of ventilation and hospitalization in PICU and reduce the incidence of VAP, but further studies are needed to identify patient categories in which it can be of benefit.
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