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van Hasselt TJ, Kanthimathinathan HK, Kothari T, Plunkett A, Gale C, Draper ES, Seaton SE. Impact of prematurity on long-stay paediatric intensive care unit admissions in England 2008-2018. BMC Pediatr 2023; 23:421. [PMID: 37620856 PMCID: PMC10463455 DOI: 10.1186/s12887-023-04254-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2023] [Accepted: 08/17/2023] [Indexed: 08/26/2023] Open
Abstract
BACKGROUND Survival following extreme preterm birth has improved, potentially increasing the number of children with ongoing morbidity requiring intensive care in childhood. Previous single-centre studies have suggested that long-stay admissions in paediatric intensive care units (PICUs) are increasing. We aimed to examine trends in long-stay admissions (≥28 days) to PICUs in England, outcomes for this group (including mortality and PICU readmission), and to determine the contribution of preterm-born children to the long-stay population, in children aged <2 years. METHODS Data was obtained from the Paediatric Intensive Care Audit Network (PICANet) for all children <2 years admitted to National Health Service PICUs from 1/1/2008 to 31/12/2018 in England. We performed descriptive analysis of child characteristics and PICU outcomes. RESULTS There were 99,057 admissions from 67,615 children. 2,693 children (4.0%) had 3,127 long-stays. Between 2008 and 2018 the annual number of long-stay admissions increased from 225 (2.7%) to 355 (4.0%), and the proportion of bed days in PICUs occupied by long-stay admissions increased from 24.2% to 33.2%. Of children with long-stays, 33.5% were born preterm, 53.5% were born at term, and 13.1% had missing data for gestational age. A considerable proportion of long-stay children required PICU readmission before two years of age (76.3% for preterm-born children). Observed mortality during any admission was also disproportionately greater for long-stay children (26.5% for term-born, 24.8% for preterm-born) than the overall rate (6.3%). CONCLUSIONS Long-stays accounted for an increasing proportion of PICU activity in England between 2008 and 2018. Children born preterm were over-represented in the long-stay population compared to the national preterm birth rate (8%). These results have significant implications for future research into paediatric morbidity, and for planning future PICU service provision.
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Affiliation(s)
- Tim J van Hasselt
- Department of Population Health Sciences, University of Leicester, Leicester, LE1 7RH, UK, University Rd.
| | | | - Trishul Kothari
- Birmingham Women's and Children's NHS Foundation Trust, Birmingham, UK
| | - Adrian Plunkett
- Paediatric Intensive Care Unit, Birmingham Women's and Children's NHS Foundation Trust, Birmingham, UK
| | - Chris Gale
- School of Public Health, Faculty of Medicine, Neonatal Medicine, Imperial College London, London, UK
| | - Elizabeth S Draper
- Department of Population Health Sciences, University of Leicester, Leicester, LE1 7RH, UK, University Rd
| | - Sarah E Seaton
- Department of Population Health Sciences, University of Leicester, Leicester, LE1 7RH, UK, University Rd
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2
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de Araujo OR, Azevedo RT, de Oliveira FRC, Colleti Junior J. Tracheostomy practices in children on mechanical ventilation: a systematic review and meta-analysis. J Pediatr (Rio J) 2022; 98:126-135. [PMID: 34509427 PMCID: PMC9432186 DOI: 10.1016/j.jped.2021.07.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/25/2021] [Revised: 07/08/2021] [Accepted: 07/09/2021] [Indexed: 12/15/2022] Open
Abstract
OBJECTIVE To evaluate current practices of tracheostomy in children regarding the ideal timing of tracheostomy placement, complications, indications, mortality, and success in decannulation. SOURCE OF DATA The authors searched PubMed, Embase, Cochrane Library, Google Scholar, and complemented by manual search. The guidelines of PRISMA and MOOSE were applied. The quality of the included studies was evaluated with the Newcastle-Ottawa Scale. Information extracted included patients' characteristics, outcomes, time to tracheostomy, and associated complications. Odds ratios (ORs) with 95% CIs were computed using the Mantel-Haenszel method. SYNTHESIS OF DATA Sixty-six articles were included in the qualitative analysis, and 8 were included in the meta-analysis about timing for tracheostomy placement. The risk ratio for "death in hospital outcome" did not show any benefit from performing a tracheostomy before or after 14 days of mechanical ventilation (p = 0.49). The early tracheostomy before 14 days had a great impact on the days of mechanical ventilation (-26 days in mean difference, p < 0.00001). The authors also found a great reduction in hospital length of stay (-31.4 days, p < 0.008). For the days in PICU, the mean reduction was of 14.7 days (p < 0.007). CONCLUSIONS The meta-analysis suggests that tracheostomy performed in the first 14 days of ventilation can reduce the time spent on the ventilator, and the length of stay in the hospital, with no effect on mortality. The decision to perform a tracheostomy early or late may be more dependent on the baseline disease than on the time spent on ventilation .
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Affiliation(s)
| | | | - Felipe Rezende Caino de Oliveira
- Instituto de Oncologia Pediátrica de São Paulo - GRAACC, São Paulo, SP, Brazil; Hospital Alvorada Moema, Departamento de Pediatria, São Paulo, SP, Brazil
| | - José Colleti Junior
- Hospital Alvorada Moema, Departamento de Pediatria, São Paulo, SP, Brazil; Hospital Assunção Rede D'Or São Luiz, Departamento de Pediatria, São Bernardo do Campo, SP, Brazil.
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3
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Kang KT, Lin YS, Lin CY, Lee CH, Hsu WC. Epidemiology of pediatric tracheotomy: A population-based study using National Health Insurance Research Database in Taiwan. Int J Pediatr Otorhinolaryngol 2022; 152:110989. [PMID: 34861553 DOI: 10.1016/j.ijporl.2021.110989] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2020] [Revised: 10/03/2021] [Accepted: 11/21/2021] [Indexed: 10/19/2022]
Abstract
OBJECTIVE Tracheostomy in children is a surgical procedure with considerable morbidity and mortality. However, there is still a lack of population-based survey in pediatric tracheostomy. This study analyses population-based data in pediatric tracheostomy among different ages in Taiwan. METHODS This study used National Health Insurance Research Database in Taiwan. All children (aged <18 years) who underwent tracheostomy during 1997-2016 were identified. We retrieved data regarding baseline characteristics, perioperative care, and mortality associated with pediatric tracheostomy, and compared differences in variables between different age groups. RESULTS We observed that 2300 children received tracheostomy (mean age, 8.7 years; 64% boys). Regarding the age group distribution of the patients, 585 (25.4%) were infants (<1 year), 227 (9.9%) were toddlers (1-3 years), 175 (7.6%) were preschool-aged children (3-6 years), 317 (13.8%) were school-aged children (6-12 years), and 996 (43.3%) were adolescents (12-18 years). Surgical indications included pulmonary disorders (64.9%), neurological disorders (38.4%), trauma (32.3%), head injury (25.2%), and congenital anomalies (21.5%). Of these patients, 94.9% required intensive care unit (ICU) care, with the mean length of ICU stay being 63.8 days. The mean length of hospital stay was 74.5 days. The overall mortality at the last follow-up was 43.96% (1011/2300), and the tracheostomy related mortality at the last follow-up was 1.43% (33/2300). Compared with adolescents, infants more commonly underwent tracheostomy in the northern area (66.7% vs 37.2%, P < .001), more commonly received tracheostomy indicated by congenital anomalies (53.7 vs 4.6%, P < .001), had longer ICU stays, had longer hospital stays (100.7 vs 57.5 days, P < .001), and had a higher 5-year mortality rate (42.4 vs 29.6%, P < .001). Multivariable logistic and Cox regression models revealed that young age was associated with an increased risk of prolonged hospital stay and long-term mortality, respectively. CONCLUSIONS This study elaborates the epidemiology of pediatric tracheostomy in different age groups.
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Affiliation(s)
- Kun-Tai Kang
- Department of Otolaryngology, Taipei Hospital, Ministry of Health and Welfare, New Taipei City, Taiwan; Department of Otolaryngology, National Taiwan University Hospital, Taipei, Taiwan; Institute of Health Policy and Management, National Taiwan University, Taipei, Taiwan
| | - Yu-Sheng Lin
- Division of Cardiology, Department of Internal Medicine, Chang Gung Memorial Hospital, Chiayi, Taiwan
| | - Che-Yi Lin
- Department of Otolaryngology, National Taiwan University Hospital, Taipei, Taiwan
| | - Chia-Hsuan Lee
- Department of Otolaryngology, Taipei Hospital, Ministry of Health and Welfare, New Taipei City, Taiwan; Department of Otolaryngology, National Taiwan University Hospital, Taipei, Taiwan; Department of Nursing, Hsin Sheng Junior College of Medical Care and Management, Taoyuan, Taiwan
| | - Wei-Chung Hsu
- Department of Otolaryngology, National Taiwan University Hospital, Taipei, Taiwan; Department of Otolaryngology, College of Medicine, National Taiwan University, Taipei, Taiwan.
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4
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Hebbar KB, Kasi AS, Vielkind M, McCracken CE, Ivie CC, Prickett KK, Simon DM. Mortality and Outcomes of Pediatric Tracheostomy Dependent Patients. Front Pediatr 2021; 9:661512. [PMID: 34017809 PMCID: PMC8129024 DOI: 10.3389/fped.2021.661512] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2021] [Accepted: 04/06/2021] [Indexed: 12/02/2022] Open
Abstract
Objective: To describe clinical factors associated with mortality and causes of death in tracheostomy-dependent (TD) children. Methods: A retrospective study of patients with a new or established tracheostomy requiring hospitalization at a large tertiary children's hospital between 2009 and 2015 was conducted. Patient groups were developed based on indication for tracheostomy: pulmonary, anatomic/airway obstruction, and neurologic causes. The outcome measures were overall mortality rate, mortality risk factors, and causes of death. Results: A total of 187 patients were identified as TD with complete data available for 164 patients. Primary indications for tracheostomy included pulmonary (40%), anatomic/airway obstruction (36%), and neurologic (24%). The median age at tracheostomy and duration of follow up were 6.6 months (IQR 3.5-19.5 months) and 23.8 months (IQR 9.9-46.7 months), respectively. Overall, 45 (27%) patients died during the study period and the median time to death following tracheostomy was 9.8 months (IQR 6.1-29.7 months). Overall survival at 1- and 5-years following tracheostomy was 83% (95% CI: 76-88%) and 68% (95% CI: 57-76%), respectively. There was no significant difference in mortality based on indication for tracheostomy (p = 0.35), however pulmonary indication for tracheostomy was associated with a shorter time to death (HR: 1.9; 95% CI: 1.04-3.4; p = 0.04). Among the co-morbid medical conditions, children with seizure disorder had higher mortality (p = 0.04). Conclusion: In this study, TD children had a high mortality rate with no significant difference in mortality based on indication for tracheostomy. Pulmonary indication for tracheostomy was associated with a shorter time to death and neurologic indication was associated with lower decannulation rates.
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Affiliation(s)
- Kiran B Hebbar
- Division of Pediatric Critical Care Medicine, Children's Healthcare of Atlanta, Emory University, Atlanta, GA, United States
| | - Ajay S Kasi
- Division of Pediatric Pulmonology, Children's Healthcare of Atlanta, Emory University, Atlanta, GA, United States
| | - Monica Vielkind
- Division of Pediatric Critical Care Medicine, Children's Healthcare of Atlanta, Emory University, Atlanta, GA, United States
| | - Courtney E McCracken
- Pediatric Biostatistics Core, Children's Healthcare of Atlanta, Emory University, Atlanta, GA, United States
| | - Caroline C Ivie
- Division of Pediatric Pulmonology, Children's Healthcare of Atlanta, Emory University, Atlanta, GA, United States
| | - Kara K Prickett
- Division of Pediatric Otolaryngology, Children's Healthcare of Atlanta, Emory University, Atlanta, GA, United States
| | - Dawn M Simon
- Division of Pediatric Pulmonology, Children's Healthcare of Atlanta, Emory University, Atlanta, GA, United States
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5
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Espahbodi M, Kallenbach S, Huang CC, Chun RH, McCormick ME. Significance of positive tracheal cultures in the 30 days following tracheostomy. Int J Pediatr Otorhinolaryngol 2020; 134:110028. [PMID: 32278988 PMCID: PMC7282989 DOI: 10.1016/j.ijporl.2020.110028] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/06/2019] [Revised: 03/27/2020] [Accepted: 03/27/2020] [Indexed: 11/28/2022]
Abstract
INTRODUCTION Positive tracheal cultures obtained after tracheostomy are often considered organ/space surgical site infections by the National Surgical Quality Improvement Project. However, the definition of bacterial tracheitis after tracheostomy is not well described. OBJECTIVE To determine the relationship of positive tracheal cultures in the 30 days following pediatric tracheostomy, antibiotic treatment of these cultures, and signs/symptoms of respiratory infection. METHODS A retrospective chart review was performed on subjects who underwent tracheostomy from November 2012-September 2017 at a tertiary care pediatric center. The following data was studied: positive tracheal cultures, antibiotic treatment for positive cultures, and other signs/symptoms of infection including fever and elevated white blood cell count. Descriptive data analysis was performed, and relative risk and 95% confidence intervals were calculated. Multivariate logistic regression model was used to assess independent association when applicable. RESULTS There were 173 subjects who met study criteria. Median age at tracheostomy was 4.6 months. Fifty-one percent (89/173) of subjects had at least one positive tracheal culture in the 30 days following tracheostomy. Of those subjects, 38% (34/89) had fever, 71% (32/45) had an elevated white blood cell count, 31% (22/72) had consolidation on chest imaging, 61% (54/89) had increased tracheal secretions, 70% (62/89) had increased ventilation requirements, and 60% (53/89) were treated with antibiotics for a diagnosis of tracheitis. There was no meaningful difference when comparing fever, increased white blood cell count, lung consolidation, increased tracheal secretions, or increased ventilation requirements in those with and without a positive tracheal culture or in those with and without antibiotic treatment for a positive culture. Multivariate logistic regression analysis showed that increased age at time of tracheostomy, more days on the ventilator after tracheostomy, and an increased number of positive cultures in the year after tracheostomy were related to having a positive tracheal culture within 30 days of tracheostomy. CONCLUSION For post-operative pediatric tracheostomy subjects, there were no meaningful differences when comparing signs/symptoms of infection between those with and without a positive tracheal culture and between those with and without antibiotic treatment for a positive culture.
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Affiliation(s)
- Mana Espahbodi
- Medical College of Wisconsin, Department of Otolaryngology, Milwaukee, WI, USA.
| | | | - Chiang-Ching Huang
- Joseph J. Zilber School of Public Health, University of Wisconsin-Milwaukee, Milwaukee, WI, USA
| | - Robert H. Chun
- Medical College Of Wisconsin, Department Of Otolaryngology, Milwaukee, WI, USA,Children’s Hospital Of Wisconsin, Department Of Otolaryngology/Medical College Of 15 Wisconsin, Milwaukee, WI, US
| | - Michael E. McCormick
- Medical College Of Wisconsin, Department Of Otolaryngology, Milwaukee, WI, USA,Children’s Hospital Of Wisconsin, Department Of Otolaryngology/Medical College Of 15 Wisconsin, Milwaukee, WI, US
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6
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Bergeron Gallant K, Sauthier M, Kawaguchi A, Essouri S, Quintal MC, Emeriaud G, Jouvet P. Tracheostomy, respiratory support, and developmental outcomes in neonates with severe lung diseases: Retrospective study in one center. Arch Pediatr 2020; 27:270-274. [PMID: 32280047 DOI: 10.1016/j.arcped.2020.03.011] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2019] [Revised: 12/27/2019] [Accepted: 03/28/2020] [Indexed: 11/17/2022]
Abstract
OBJECTIVES Pediatric tracheostomy has evolved significantly in the past few decades and the optimal timing to perform it in children with respiratory assistance is still debated. The objective of this study was to describe the indications, timing, complications, and outcomes of infants on respiratory support who had a tracheostomy in a tertiary pediatric intensive care unit (PICU). METHODS All children younger than 18 months of corrected age requiring respiratory support for at least 1 week and who had a tracheostomy between January 2005 and December 2015 were included. Their demographic and clinical data and their outcomes at 24 months of corrected age were collected and analyzed after approval from the CHU Sainte-Justine ethics committee. RESULTS During the study period, 18 children (14 preterm infants, 4 polymalformative syndromes, and 2 diaphragmatic hernias) were included. The median corrected age at tracheostomy was 97 days (0-289 days) and 94.4% were elective. The indications for tracheostomy were ventilation for more than 7 days with (61.1%) or without (38.9%) orolaryngotracheal anomaly. The median number of consultants involved per patient was 16 consultants (10-23 consultants). The median hospital length of stay was 122 days (8-365 days) before tracheostomy and 235 days (22-891 days) after tracheostomy. The median invasive ventilation time was 68 days (8-168 days) before tracheostomy and 64 days (5-982 days) after tracheostomy. In terms of complications, there were nine cases of tracheitis and five cases of tracheal granulomas. At 24 months of corrected age, 17 of 18 children survived, one of/17 was still hospitalized, three of 17 were decannulated, three of 17 received respiratory support via their tracheostomy, 11 of 17 were fed with a gastrostomy, and all had neurodevelopmental delay. CONCLUSION Tracheostomy in infants requiring at least 1 week of ventilation is performed for complex cases and is favored for orolaryngotracheal anomalies. Clinicians should anticipate the need for developmental care in this population.
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Affiliation(s)
- K Bergeron Gallant
- Pediatric Intensive Care Unit, CHU Sainte-Justine, Montreal, Canada; University of Montreal, Montreal, Canada
| | - M Sauthier
- Pediatric Intensive Care Unit, CHU Sainte-Justine, Montreal, Canada; University of Montreal, Montreal, Canada
| | - A Kawaguchi
- Pediatric Intensive Care Unit, CHU Sainte-Justine, Montreal, Canada; University of Montreal, Montreal, Canada; University of Ottawa, Children's Hospital of Eastern Ontario, Ottawa, Canada
| | - S Essouri
- Pediatric Intensive Care Unit, CHU Sainte-Justine, Montreal, Canada; University of Montreal, Montreal, Canada
| | - M C Quintal
- Pediatric Intensive Care Unit, CHU Sainte-Justine, Montreal, Canada; University of Montreal, Montreal, Canada
| | - G Emeriaud
- Pediatric Intensive Care Unit, CHU Sainte-Justine, Montreal, Canada; University of Montreal, Montreal, Canada
| | - P Jouvet
- Pediatric Intensive Care Unit, CHU Sainte-Justine, Montreal, Canada; University of Montreal, Montreal, Canada.
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McKelvie BL, Lobos AT, Chan J, Momoli F, McNally JD. High Rate of Medical Emergency Team Activation in Children with Tracheostomy. J Pediatr Intensive Care 2019; 9:27-33. [PMID: 31984154 DOI: 10.1055/s-0039-1695733] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2019] [Accepted: 07/19/2019] [Indexed: 10/26/2022] Open
Abstract
Pediatric in-patients with tracheostomy (PIT) are at high risk for clinical deterioration. Medical emergency teams (MET) have been developed to identify high-risk patients. This study compared MET activation rates between PITs and the general ward population. This was a retrospective cohort study conducted at a tertiary pediatric hospital. The primary outcome (MET activation) was obtained from a database. Between 2008 and 2014, the MET activation rate was significantly higher in the PIT group than the general ward population (14 vs. 2.9 per 100 admissions, p < 0.001). PITs are at significantly higher risk for MET activation. Strategies should be developed to reduce their risk on the wards.
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Affiliation(s)
- Brianna L McKelvie
- Division of Critical Care, Department of Pediatrics, Faculty of Medicine, Western University, Children's Hospital-London Health Sciences Centre, London, Ontario, Canada
| | - Anna-Theresa Lobos
- Division of Critical Care, Department of Pediatrics, Faculty of Medicine, University of Ottawa, Children's Hospital of Eastern Ontario, Ottawa, Ontario, Canada
| | - Jason Chan
- Children's Hospital of Eastern Ontario Research Institute, Ottawa, Ontario, Canada
| | - Franco Momoli
- Children's Hospital of Eastern Ontario Research Institute, Ottawa, Ontario, Canada
| | - James Dayre McNally
- Division of Critical Care, Department of Pediatrics, Faculty of Medicine, University of Ottawa, Children's Hospital of Eastern Ontario, Ottawa, Ontario, Canada.,Children's Hospital of Eastern Ontario Research Institute, Ottawa, Ontario, Canada
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Sakai M, Kou YF, Shah GB, Johnson RF. Tracheostomy demographics and outcomes among pediatric patients ages 18 years or younger-United States 2012. Laryngoscope 2018; 129:1706-1711. [DOI: 10.1002/lary.27463] [Citation(s) in RCA: 34] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2018] [Revised: 05/23/2018] [Accepted: 07/02/2018] [Indexed: 01/01/2023]
Affiliation(s)
- Mark Sakai
- University of Texas Southwestern Medical School; Dallas Texas
| | - Yann-Fuu Kou
- Department of Otolaryngology-Head and Neck Surgery; Division of Pediatric Otolaryngology, University of Texas Southwestern Medical Center; Dallas Texas
| | - Gopi B. Shah
- Department of Otolaryngology-Head and Neck Surgery; Division of Pediatric Otolaryngology, University of Texas Southwestern Medical Center; Dallas Texas
- Department of Pediatric Otolaryngology; Children's Health, Children's Medical Center Dallas; Dallas Texas U.S.A
| | - Romaine F. Johnson
- Department of Otolaryngology-Head and Neck Surgery; Division of Pediatric Otolaryngology, University of Texas Southwestern Medical Center; Dallas Texas
- Department of Pediatric Otolaryngology; Children's Health, Children's Medical Center Dallas; Dallas Texas U.S.A
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9
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McPherson ML, Shekerdemian L, Goldsworthy M, Minard CG, Nelson CS, Stein F, Graf JM. A decade of pediatric tracheostomies: Indications, outcomes, and long-term prognosis. Pediatr Pulmonol 2017; 52:946-953. [PMID: 28263440 DOI: 10.1002/ppul.23657] [Citation(s) in RCA: 60] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2016] [Revised: 11/03/2016] [Accepted: 11/27/2016] [Indexed: 11/10/2022]
Abstract
OBJECTIVE To define the mortality and long-term outcomes of children undergoing tracheostomy. DESIGN Retrospective chart and Texas Department of Health Bureau of Vital Statistics review of patients admitted to a Pediatric Intensive Care Unit who underwent a tracheostomy between 2001 and 2011. Mortality and decannulation rates were compared based on tracheostomy indication and age. SUBJECTS A total of 426 patients admitted to a Pediatric Intensive Care Unit in a large tertiary children's hospital. RESULTS The median patient age was 1.5 years (3 days-24 years). Primary indications for tracheostomy included (a) airway obstruction, (b) congenital neurologic disease, (c) acquired neurologic disease, (d) congenital respiratory disease, and (e) acquired respiratory disease. Overall, 98 patients (23%) died during the study period, and 75th percentile survival time was 5.9 years (95%CI: 3-8). Patients undergoing a tracheostomy for airway obstruction were the least likely to die; while patients with acquired neurologic disease were most likely to die. A total of 163 patients (38%) were decannulated, and 50% were decannulated at 1.2 years (95%CI: 0.9-1.5). Patients with congenital neurologic disease were the least likely to undergo decannulation. Over half of the patients were discharged from the hospital requiring some form of mechanical respiratory support in addition to their tracheostomy. CONCLUSIONS In this largest cohort of long-term follow-up to date, we have shown the overall risk of mortality varied according to the indication for the tracheostomy. We were unable to determine exact causes of death. The likelihood of being decannulated also correlates with the underlying indication for the tracheostomy. Pediatr Pulmonol. 2017; 52:946-953. © 2017 Wiley Periodicals, Inc.
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Affiliation(s)
- Mona L McPherson
- Department of Pediatrics, Baylor College of Medicine, Texas Children's Hospital, Section of Critical Care Medicine, Fannin 6621, WT 6-006, Houston 77030, Texas
| | - Lara Shekerdemian
- Department of Pediatrics, Baylor College of Medicine, Texas Children's Hospital, Section of Critical Care Medicine, Fannin 6621, WT 6-006, Houston 77030, Texas
| | - Michelle Goldsworthy
- Department of Pediatrics, Baylor College of Medicine, Texas Children's Hospital, Section of Critical Care Medicine, Fannin 6621, WT 6-006, Houston 77030, Texas
| | - Charles G Minard
- Baylor College of Medicine, Dan L. Duncan Institute for Clinical and Translation Research, Houston, Texas
| | - Cynthia S Nelson
- Department of Pediatrics, Baylor College of Medicine, Texas Children's Hospital, Section of Critical Care Medicine, Fannin 6621, WT 6-006, Houston 77030, Texas
| | - Fernando Stein
- Department of Pediatrics, Baylor College of Medicine, Texas Children's Hospital, Section of Critical Care Medicine, Fannin 6621, WT 6-006, Houston 77030, Texas
| | - Jeanine M Graf
- Department of Pediatrics, Baylor College of Medicine, Texas Children's Hospital, Section of Critical Care Medicine, Fannin 6621, WT 6-006, Houston 77030, Texas
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10
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McCrory MC, Lee KJ, Scanlon MC, Wakeham MK. Predictors of need for mechanical ventilation at discharge after tracheostomy in the PICU. Pediatr Pulmonol 2016; 51:53-9. [PMID: 25823590 DOI: 10.1002/ppul.23195] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/12/2014] [Revised: 01/21/2015] [Accepted: 02/23/2015] [Indexed: 11/11/2022]
Abstract
BACKGROUND The objective of this study was to determine factors predictive of need for mechanical ventilation (MV) upon discharge from the pediatric intensive care unit (PICU) among patients who receive a tracheostomy during their stay. METHODS This was a retrospective cohort study using the Virtual PICU Systems (VPS) database. Patients <18 years old admitted between 2009-2011 who required MV for at least 3 days and received a tracheostomy during their PICU stay were included. RESULTS A total of 680 pediatric patients from 74 PICUs were included, of whom 347 (51%) remained on MV at the time of PICU discharge. Neonates (30/38, 79%) and infants (129/203, 64%) required MV at PICU discharge after tracheostomy more often than adolescents (66/141, 47%) and children (122/298, 41%). Time on MV pre-tracheostomy was longer among those who required MV at discharge (median 18.3 vs. 13.8 days, P < 0.0001); however, number of failed extubations was similar (median 1 for both groups, P = 0.97). On mixed-effects multivariable regression analysis, the age categories of neonate (OR 2.9, 95%CI 1.1-7.6, P = 0.03), and infant (OR 1.7, 95%CI 1.1-2.8, P = 0.03), and ventilator days prior to tracheostomy (OR 1.01, 95%CI 1.0-1.02, P = 0.01) were significantly associated with increased odds of MV upon PICU discharge, while being a trauma admission was associated with decreased odds (OR 0.45, 95%CI 0.28-0.73, P = 0.001). CONCLUSIONS Younger patients and those with prolonged courses of MV prior to tracheostomy are more likely to continue to need MV upon PICU discharge.
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Affiliation(s)
- Michael C McCrory
- Section on Pediatric Critical Care Medicine, Department of Anesthesiology, Wake Forest School of Medicine, Winston-Salem, North Carolina
| | - K Jane Lee
- Department of Pediatrics, Division of Pediatric Critical Care, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Matthew C Scanlon
- Department of Pediatrics, Division of Pediatric Critical Care, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Martin K Wakeham
- Department of Pediatrics, Division of Pediatric Critical Care, Medical College of Wisconsin, Milwaukee, Wisconsin
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Abstract
OBJECTIVES Tracheostomy is a common procedure in the ICU when prolonged mechanical ventilation is expected. Although adult data show morbidity and mortality benefits over translaryngeal intubation, there is no consensus on optimal timing. In the pediatric population, there is sparse data regarding morbidities associated with duration of ventilation prior to tracheostomy. Our objective was to associate timing of tracheostomy with clinical outcomes in PICU patients. DESIGN This is a retrospective cohort study of patients undergoing tracheostomy. Patient factors and duration of ventilation prior to tracheostomy were collected on each patient. Morbidities such as ventilator-associated pneumonia, central catheter-associated bloodstream infection, and cardiopulmonary arrests were examined both pre- and posttracheostomy. ICU and total hospital length of stay as well as mortality were recorded. For data analysis regarding tracheostomy timing, patients were stratified into early and late groups using a cutoff of 14 days. SETTING The PICUs and cardiac ICUs in a quaternary-care children's hospital. PATIENTS All patients undergoing tracheostomy over a 3-year period. MEASUREMENTS AND MAIN RESULTS Seventy-three patients were analyzed with a median of 22 days of ventilation prior to tracheostomy. Patient factors associated with longer pretracheostomy ventilation included congenital heart disease and vasoactive drug use. Clinical events associated with longer pretracheostomy ventilation included bloodstream infection, ventilator-associated pneumonia, and cardiac arrest. Age, congenital heart disease, vasoactive drug use, bloodstream infection, and ventilator-associated pneumonia each independently increased pretracheostomy ventilator days. Median ICU length of stay after tracheostomy was 18 days. For each pretracheostomy ventilator day, ICU length of stay increased by 0.5 days and hospital length of stay increased by 1.9 days. For patients undergoing early tracheostomy, ICU and total hospital lengths of stay were 4 days and 4 weeks shorter, respectively. CONCLUSIONS Analysis of our results suggests that a longer duration of ventilation prior to tracheostomy is associated with increased ICU morbidities and length of stay. Early tracheostomy may have significant benefits without adversely affecting mortality.
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Tracheotomie und Trachealkanülen im Kindesalter. Notf Rett Med 2013. [DOI: 10.1007/s10049-012-1616-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Retrospective, cross-sectional review of delayed discharge after paediatric tracheostomy. The Journal of Laryngology & Otology 2012; 126:1247-53. [DOI: 10.1017/s0022215112002289] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
AbstractObjectives:To investigate reasons for prolonged hospitalisation of children with tracheostomies once they are medically fit for discharge.Methods:Retrospective, cross-sectional study of 101 children undergoing tracheostomy between 2000 and 2010.Results:Of the study patients, 44.6 per cent did not spend any time in hospital once medically fit, 19.8 per cent spent up to two weeks, 12.9 per cent spent between two weeks and one month, and 22.8 per cent spent over one month. Of the 56 cases with delayed discharge, the majority (22 children, 39.3 per cent) were delayed due to time taken obtaining parental competencies in tracheostomy management. A number of external factors were identified in these delays: parental substance abuse; single parenting; concerns about parenting ability, and English not being the parents' first language.Conclusion:Paediatric tracheostomy may lead to prolonged hospitalisation, but this is often influenced by social factors. Better use of dedicated specialist paediatric tracheostomy nurses may reduce unnecessary hospitalisation.
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Benneyworth BD, Gebremariam A, Clark SJ, Shanley TP, Davis MM. Inpatient health care utilization for children dependent on long-term mechanical ventilation. Pediatrics 2011; 127:e1533-41. [PMID: 21576303 PMCID: PMC3103275 DOI: 10.1542/peds.2010-2026] [Citation(s) in RCA: 76] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVE The objective was to describe the characteristics of pediatric discharges associated with long-term mechanical ventilation (LTMV) compared with those with complex chronic conditions (CCCs), and evaluate trends over time in health care utilization for the discharges associated with LTMV. METHODS The Kids' Inpatient Database, compiled by the Agency for Healthcare Research and Quality, was used. Routine newborn care was excluded. Discharges associated with LTMV were identified by using the International Classification of Diseases, Ninth Revision, code v46.1x and compared with discharges associated with CCCs in 2006 using simple regression and χ(2) analyses. Trends in LTMV-associated discharges from 2000 to 2006 were assessed using variance-weighted least squares regression. RESULTS In 2006, there were an estimated 7812 discharges associated with LTMV. Compared with discharges for children with CCCs, LTMV discharges had significantly higher mortality, longer lengths of stay, higher mean charges, more emergency department admissions, and more discharges to long-term care. From 2000 to 2006, there was a 55% increase in the number of LTMV discharges and a concurrent 70% increase in aggregate hospital charges. The majority of LTMV discharges occurred in children 4 years old and younger, and ∼50% of the aggregate charges were for children younger than 1 year. CONCLUSIONS Discharges for children associated with LTMV require substantively greater inpatient resource use than other children with CCCs. As the number of discharges and associated aggregate charges increase over time, additional research must examine patterns of care for specific clinical subgroups of LTMV, especially children aged 4 years and younger.
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Affiliation(s)
- Brian D. Benneyworth
- Child Health Evaluation and Research Unit, Division of General Pediatrics, ,Division of Pediatric Critical Care Medicine, and
| | | | - Sarah J. Clark
- Child Health Evaluation and Research Unit, Division of General Pediatrics
| | | | - Matthew M. Davis
- Child Health Evaluation and Research Unit, Division of General Pediatrics, ,Division of General Medicine and Gerald R. Ford School of Public Policy, University of Michigan, Ann Arbor, Michigan
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