Timing of Tracheostomy, Weaning from Mechanical Ventilation and Duration of Hospitalization among a Sample of Pediatric Patients

Abstract

Objective: To determine if there is a difference in the duration of mechanical ventilation and hospitalization between patients who underwent early compared to late tracheostomy.
 Methods:
 Design: Causal-Comparative (ex post facto) Chart Review
 Setting: Tertiary National University Hospital
 Participants: Records of 68 pediatric patients who underwent elective tracheostomy from January 1, 2013 to June 30, 2018 were considered for inclusion. Patients were excluded if invasive mechanical ventilation was not done prior to tracheostomy, if they underwent emergency tracheostomy or had incomplete records. Selected patients were categorized in the early tracheostomy group if the procedure was performed within 14 days of mechanical ventilation and late tracheostomy group if performed beyond 14 days. Early post-tracheostomy weaning from mechanical ventilation was defined as less than 7 days from time of tracheostomy.
 Results: A total of 21 patients were included, 6 in the early tracheostomy group and 15 in the late tracheostomy group. Although early tracheostomy did not show significant association with shortened post-tracheostomy duration of mechanical ventilation (O.R. 6; C.I. 0.276 to 130.322; p = .476), two-sample t-tests showed the early tracheostomy group had a significantly shorter mean duration of mechanical ventilation and hospitalization compared to the late tracheostomy group (13.17 vs. 54.13 days, p = .0012; 21.17 vs. 66.67 days, p = .0032).
 Conclusion: Although early tracheostomy does not shorten post-tracheostomy mechanical ventilation support, there is a significant difference in the duration of mechanical ventilation and hospitalization between early and late tracheostomy groups and this may suggest potential benefits of performing tracheostomy earlier in children.
 
 Keywords: tracheotomy; pediatric; mechanical ventilation; hospitalization

Tracheostomy practices in children on mechanical ventilation: a systematic review and meta-analysis

“…The search did not return any randomized trials. The authors found eight studies 63 , 64 , 65 , 66 , 67 , 68 , 69 , 70 that compared the prognoses of patients undergoing “early” or “late” tracheostomy: in five, “early tracheostomy” was defined as being performed before 14 days of mechanical ventilation, and “late,” after this period. In two studies, “early” was defined as before seven days post-trauma injury, and, in one, as before ten days of ventilation ( Table 2 ).…”

“… <10 days of MV 37/33 Death in PICU 9.8 (7) 26.8 (12.9) 7 Lee et al, 2016 67 Retrospective cohort General PICU Age range: 1 mo. - 18 y ≤14 days of MV 61/50 30 days and 1 year-mortality 9.2 (5.4) 37.9 (30.6) 8 Ferrolino et al, 2019 68 Retrospective cohort General PICU Age range: 2 mo. - 12 y.…”