Tracheostomy trends in paediatric intensive care.

Area of Science:

• Pediatric critical care medicine
• Respiratory medicine
• Surgical outcomes

Background:

• Pediatric tracheostomy is frequently performed in pediatric intensive care units (PICUs) to support prolonged mechanical ventilation.
• Understanding trends in tracheostomy procedures is crucial for optimizing pediatric critical care.
• Variability in clinical practice can impact patient outcomes and resource allocation.

Purpose of the Study:

• To analyze trends in tracheostomy practices within UK PICUs from 2003 to 2017.
• To investigate the incidence and proportion of tracheostomies performed during PICU admissions.
• To identify variations in tracheostomy rates across different PICUs.

Main Methods:

• Retrospective analysis of data from 250,261 PICU admissions between 2003 and 2017.
• Inclusion of 4,409 children who underwent tracheostomy during the study period.
• Calculation of incidence rate ratios and proportions to assess trends and variability.

Main Results:

• The overall incidence of pediatric tracheostomy in PICUs halved between 2003 and 2017 (IRR=0.48).
• The proportion of PICU admissions involving tracheostomy decreased from 2.44% in 2003 to 0.97% in 2017.
• Significant variability in tracheostomy rates was observed across different PICUs, ranging from 0.0% to 4.0% of admissions.

Conclusions:

• Pediatric tracheostomy rates in UK PICUs have declined substantially over a 15-year period.
• Despite the overall downward trend, significant inter-PICU variability in tracheostomy practice remains.
• Risk-adjusted mortality for tracheostomized children in PICU was comparable to that of all PICU admissions.