Tracheostomy before 14 Days: Is It Associated with Better Outcomes in Pediatric Patients on Prolonged Mechanical Ventilation?

Abstract

A bstract 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.

Indication‐based timing of tracheostomy and its effects on outcome in the pediatric intensive care unit

“…Rane et al reported lower neonatal mortality in ET group but it was not found to be an independent risk factor 22 . A recent pediatric study reported statistically significant higher number of decannulation in ET group 13 . We did not find any difference in decannulation rate between ET and LT patients except in NMD category.…”

“…22 A recent pediatric study reported statistically significant higher number of decannulation in ET group. 13 We did not find any difference in decannulation rate between ET and LT patients except in NMD category. The reason for significantly delayed decannulation in NMD cases was due to inclusion of many cases of acute cervical cord injury and myelitis in ET group.…”

“…All studies were retrospective in design. The ET in children was defined by cut‐off time based on adult studies, personnel experience, and on survey results 9,11,13,20,21 . For present study, we categorized study cohort according to four specific indications of tracheostomy.…”

“…7,8 There are few reports on the timing of tracheostomy and its effects on morbidity and mortality in children from developed and developing countries. [9][10][11][12][13] This study was conducted to fill the lacunae in the knowledge about the effects of timing of tracheostomy on the outcome in children.…”

Traqueostomía en Prematuros Con Displasia Broncopulmonar Grave

“…La indicación de traqueostomía por VMI prolongada en población pediátrica es más infrecuente y se encuentra menos estandarizada, y aunque tiene los mismos potenciales efectos beneficiosos que en adultos, la evidencia tiene su origen solo en estudios de cohorte retrospectivos (11)(12)(13). La tendencia observada en pacientes pediátricos es al aumento en la consideración de traqueostomía para los niños con VMI prolongada.…”