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Factors affecting tracheostomy in critically ill paediatric patients in Japan: a data-based analysis
Tadashi Ishihara1, Hiroshi Tanaka2
1Department of Emergency and Critical Care Medicine, Juntendo University, Urayasu Hospital, Urayasu-city, Chiba, Japan. ta-shi.0517@hotmail.co.jp.
Insights
Tracheostomy is performed in 3.1% of critically ill children in Japan, with chronic conditions and respiratory failure being key risk factors. This study identifies factors associated with tracheostomy in pediatric intensive care. Keywords: tracheostomy, pediatric intensive care, risk factors, chronic conditions.
Area of Science:
- Pediatric critical care medicine
- Epidemiology
- Respiratory care
Background:
- Increasing survival of children with complex medical needs often requires tracheostomy and home ventilation.
- Tracheostomy is a crucial intervention for managing chronic diseases in critically ill pediatric patients.
Purpose of the Study:
- To describe the indications, epidemiology, frequency, and associated factors for tracheostomy in critically ill pediatric patients.
- Utilize data from the Japanese Registry of Paediatric Acute Care (JaRPAC) for comprehensive analysis.
Main Methods:
- Multicenter epidemiologic study using the JaRPAC database.
- Inclusion of pediatric patients (≤16 years) admitted to Intensive Care Units (ICUs) or Pediatric Intensive Care Units (PICUs) without tracheostomy.
- Comparison of patients with and without tracheostomies at discharge.
Main Results:
- Out of 6199 registered patients, 181 (3.1%) underwent tracheostomy.
- Significant associations found between tracheostomy and chronic conditions (74.0%), chromosomal anomalies (10.5%), urgent admission (83.4%), respiratory failure (33.7%), and post-cardiac pulmonary arrest resuscitation (22.1%).
- Patients with tracheostomies showed higher rates of chronic conditions, chromosomal anomalies, and urgent admissions compared to those without.
Conclusions:
- This study is the first large-scale report from Japan on tracheostomy factors in critically ill children.
- Chronic conditions (especially neuromuscular disease), chromosomal anomalies, respiratory failure, and post-cardiac pulmonary arrest resuscitation are potential risk factors for tracheostomy in this population.
Background:
There has been an increasing number of children surviving with high medical needs, for whom tracheostomy and/or home ventilation is part of their chronic disease management. The purpose of this study was to describe the indications, epidemiology, frequency, and associated factors for tracheostomy in critically ill paediatric patients using the data available in the Japanese Registry of Paediatric Acute Care (JaRPAC).
Methods:
This multicentre epidemiologic study collected data concerning paediatric tracheostomy from the JaRPAC database. Patients were divided into two groups: those with or without tracheostomies when they were discharged from the Intensive Care Unit (ICU) or Paediatric Intensive Care Unit (PICU). Consecutive patients aged ≤16 years who did not undergo tracheostomy when admitted to ICU or PICU between April 2014 and March 2017 were included.
Results:
A total of 23 hospitals participated, involving 6199 paediatric patients registered in the JaRPAC database during the study period. Of the registered paediatric patients, 5769 (95%) patients were admitted to the ICUs or PICUs without tracheostomies. Among the patients, 181 patients (3.1%) had undergone tracheostomies. There were significant differences in chronic conditions (134, 74.0% versus 3096, 55.4%, p < 0.01), chromosomal anomalies (19, 10.5% versus 326, 5.8%, p < 0.01), urgent admission (151, 83.4% versus 3093, 55.4%, p < 0.01). More tracheostomies were performed on patients who were admitted for respiratory failure (61, 33.7% versus 926, 16.1%, p < 0.01) and for post-cardiac pulmonary arrest (CPA) resuscitation (40, 22.1% versus 71, 1.1%, p < 0.01).
Conclusions:
This is the first report to use a large-scale registry of critically ill paediatric patients in Japan to describe the interrelated factors of tracheostomies. Chronic conditions (especially for neuromuscular disease), chromosomal anomaly, admission due to respiratory failure, or treatment for post-CPA resuscitation all had the possibility to be risk factors for tracheostomy.
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