Related Experiment Video
Updated: Dec 30, 2025
Guidelines for Elective Pediatric Fiberoptic Intubation
Published on: January 17, 2011
Timing of Tracheostomy in Pediatric Patients: A Systematic Review and Meta-Analysis
Ahmed Abdelaal Ahmed Mahmoud M Alkhatip1,2, Mohamed Younis3, Negar Jamshidi4
1Department of Anesthesia, Pain Management and Surgical Intensive Care, Beni-Suef University Hospital and Faculty of Medicine, Beni Suef University, Beni Suef, Egypt.
Insights
Early tracheostomy in children on mechanical ventilation may reduce mortality and hospital stay. Further high-quality randomized trials are needed to confirm these findings in pediatric patients.
Area of Science:
- Pediatric critical care medicine
- Respiratory and sleep medicine
- Surgical interventions
Background:
- Tracheostomy is a common procedure in critically ill adults.
- Indications for pediatric tracheostomy in complex conditions are increasing.
- Optimal timing for pediatric tracheostomy in prolonged ventilation lacks guidelines.
Purpose of the Study:
- To systematically review and meta-analyze the impact of early versus late tracheostomy in pediatric patients.
- To evaluate the effect of tracheostomy timing on key clinical outcomes in mechanically ventilated children.
Main Methods:
- Systematic literature search of MEDLINE, Embase, and Cochrane Library databases.
- Inclusion of clinical trials, observational studies, and cohort studies comparing early and late tracheostomy in children.
- Meta-analysis using random effects models for continuous and dichotomous outcomes.
Main Results:
- Eight retrospective cohort studies (10 study arms) were included in the meta-analysis.
- Early tracheostomy was associated with significant reductions in mortality, duration of mechanical ventilation, and hospital stay.
- Findings remained consistent even after accounting for imputed variance in some studies.
Conclusions:
- Early tracheostomy in pediatric patients on mechanical ventilation may lead to improved medical outcomes.
- The current evidence base, primarily from retrospective studies, highlights an urgent need for high-quality randomized controlled trials in this population.
Objectives:
Tracheostomy is a very common clinical intervention in critically ill adult patients. The indications for tracheostomy procedures in pediatric patients with complex conditions have increased dramatically in recent years, but there are currently no guidelines on the optimal timing of tracheostomy in pediatric patients undergoing prolonged ventilation.
Data Sources:
We performed a systematic search of the existing literature in MEDLINE via PubMed and Embase databases and the Cochrane Library to identify clinical trials, observational studies, and cohort studies that compare early and late tracheostomy in children. The date of the last search was August 27, 2018. Included articles were subjected to manual searching.
Study Selection:
Studies in mechanically ventilated children that compared early with late tracheostomy were included.
Data Extraction:
Data were extracted into a spreadsheet and copied into Review Manager 5.3 (The Cochrane Collaboration, Copenhagen, Denmark).
Data Synthesis:
Data were meta-analyzed using an inverse variance, random effects model. Continuous outcomes were calculated as mean differences with 95% CIs, and dichotomous outcomes were calculated as Mantel-Haenszel risk ratios with 95% CIs. We included eight studies (10 study arms). These studies were all retrospective cohort studies. Early tracheostomy was associated with significant reductions in mortality, days on mechanical ventilation, and length of intensive care and total hospital stay, although the lack of randomized, controlled trials limits the validity of these findings. Although variance was imputed for some studies, these conclusions did not change after removing these studies from the analysis.
Conclusions:
In children on mechanical ventilation, early tracheostomy may improve important medical outcomes. However, our data demonstrate the urgent need for high-quality, randomized controlled trials in the pediatric population.
Related Concept Videos
01:23Oxygen Delivering System III: Tracheostomy and T-piece
Tracheostomy
A tracheostomy is a surgically created opening (stoma) in the anterior part of the trachea. It is used to establish a patient airway, bypass an upper airway obstruction, simplify the removal of secretions, permit long-term...
01:21Tracheostomy Decannulation
Description of the Procedure
Decannulation refers to the permanent removal of the tracheostomy tube, signaling the resolution of the condition that initially necessitated the tracheostomy. The process requires a well-coordinated interplay between...
01:16Tracheostomy Care I: Pre-procedural Steps
Required Equipment
The equipment necessary for tracheostomy care includes:
01:28Tracheostomy: Procedure and Tubes
Tracheostomy tubes can be made of semiflexible plastic (polyurethane or silicone), rigid plastic, or metal, and they come in...
01:22Trachea
Anatomical Features:
Location: About half of the trachea is situated in the neck, anterior to the esophagus, and extends from the larynx (at the level of...
01:16Oxygen Delivering System II: Venturi Mask and Transtracheal Oxygen
Venturi Mask
The Venturi mask, named after the Venturi effect, is designed to deliver precise oxygen concentrations. It consists of a large tube with an oxygen inlet that narrows down, causing a pressure drop that pulls air in through adjustable side ports. The mask is a lightweight,...