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Tracheostomy before 14 Days: Is It Associated with Better Outcomes in Pediatric Patients on Prolonged Mechanical
Mihir Sarkar1, Satyabrata Roychowdhoury1, Subhajit Bhakta1
1Department of Pediatrics, Calcutta Medical College, Kolkata, West Bengal, India.
Insights
Early tracheostomy in children needing prolonged mechanical ventilation (MV) leads to fewer complications and better outcomes. This study found that performing tracheostomy within 14 days of MV improves decannulation and weaning rates, reducing intensive care stays.
Area of Science:
- Pediatric Critical Care Medicine
- Respiratory Medicine
- Surgical Procedures
Background:
- Advancements in pediatric critical care necessitate prolonged mechanical ventilation (MV) for many children.
- Tracheostomy is often recommended for these patients, but concerns exist regarding its safety, feasibility, and outcomes.
- Data on the optimal timing of tracheostomy in pediatric patients requiring prolonged MV is limited.
Purpose of the Study:
- To analyze the clinical characteristics, indications, duration, and outcomes of tracheostomized children.
- To compare outcomes based on the timing of tracheostomy relative to the initiation of mechanical ventilation.
Main Methods:
- Retrospective study of 87 pediatric patients (<12 years) undergoing tracheostomy after ≥96 hours of MV.
- Patients divided into 'early' (<14 days) and 'late' (>14 days) tracheostomy groups.
- Analysis of demographics, indications, complications, decannulation, weaning rates, and length of stay.
Main Results:
- Early tracheostomy (<14 days) was associated with significantly lower complication rates (OR, 2.95; p=0.03).
- The early group demonstrated higher decannulation (OR, 5.17; p=0.01) and weaning rates (OR, 5.94; p=0.032).
- Late tracheostomy correlated with longer MV duration, PICU stay, and overall hospital stay.
Conclusions:
- Performing tracheostomy within 14 days of initiating mechanical ventilation in pediatric patients is associated with better outcomes.
- Early tracheostomy reduces complications and improves weaning success, leading to more efficient use of intensive care resources.
- This finding supports earlier consideration of tracheostomy for children requiring prolonged mechanical ventilation.
Introduction:
With the advancement of pediatric critical care services across India, many children require prolonged mechanical ventilation (MV), and tracheostomy is recommended to them. However, many pediatric intensivists have concerns regarding the safety, feasibility, and outcome of tracheostomy.We aimed to analyze clinical characteristics, indication, duration, and outcome of tracheostomized children with respect to timing of tracheostomy.
Materials And Methods:
We conducted a retrospective study from the hospital clinical database of consecutive patients below 12 years who had undergone tracheostomy after admission into the pediatric intensive care unit (PICU) for prolonged ventilation (≥96 hours) from January 2015 to December 2019. The study was approved by the Institutional Ethics Committee. Patients were divided into two groups: tracheostomies done within 14 days of MV (early tracheostomy) and patients with tracheostomies performed after 14 days (late tracheostomy). Patients' age, sex, indications, complications, decannulation rate, length of MV, PICU, and hospital stay were analyzed.
Results:
Of the 1,425 patients on invasive MV, 87 (6.1%) patients required tracheostomy after a mean 13.37 days of MV. The most common indication was encephalopathy 32 (36.7%) followed by acute respiratory distress syndrome 20 (22.9%). Factors like higher pediatric logistic organ dysfunction score, vasoactive inotrop score, incidence of pretracheostomy ventilator-associated pneumonia, and difficulty in obtaining parental consent were associated with late tracheostomy. The early tracheostomy group had a higher decannulation rate (odds ratio, 5.17; p, 0.01) and weaning rate (odds ratio, 5.94; p, 0.032). The late tracheostomy group needed a longer duration of MV, PICU, and hospital stay. Complications of tracheostomy were less in the early tracheostomy patients (odds ratio, 2.95; p, 0.03).
Conclusion:
Early tracheostomy was associated with lower complications, higher successful weaning rates, and less utilization of intensive care facilities in patients receiving prolonged MV.
Clinical Significance:
In the context of scarcity of data on the timing of tracheostomy in children with prolonged ventilation (≥96 hours) the study shows that early (<14 days) tracheostomy is associated with a better outcome.
How To Cite This Article:
Sarkar M, Roychowdhoury S, Bhakta S, Raut S, Nandi M. Tracheostomy before 14 Days: Is It Associated with Better Outcomes in Pediatric Patients on Prolonged Mechanical Ventilation? Indian J Crit Care Med 2021;25(4):435-440.
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