Effect of early vs. late tracheostomy on clinical outcomes in critically ill pediatric patients

Lee, Ji Hyun; Koo, Chang Hoon; Lee, S. Y.; Kim, Eun‐Hee; Song, In Kyung; Kim, Hee‐Soo; Kim, C. S.; Kim, Jin‐Tae

doi:10.1111/aas.12760

Cited by 23 publications

(39 citation statements)

References 27 publications

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“…The cut-off of 14 days to delineate between early and late tracheostomy was extrapolated from adult studies cited by Holloway et al 8 In their study of 73 pediatric patients, they determined that the total hospital length of stay was 4 weeks shorter in the early tracheostomy group. A similar study of 111 pediatric patients by Lee et al 5 showed a significantly shorter duration of MV, and length of ICU and hospital stay in the early tracheostomy group. In this study, a cut-off of 14 days was also used to classify patients into early and late tracheostomy groups.…”

Section: Resultsmentioning

confidence: 61%

“…10 In contrast, there is still seems to be no definite criteria with regards the timing of tracheostomy in pediatric patients. 4,5 A survey of 28 pediatric intensive care units in the UK showed variation in answers with regards to the duration of invasive ventilation before considering tracheostomy: four units suggested less than 14 days of mechanical ventilation while other units suggested > 14 days or > 28 days with some respondents even considering more than 90 days. 11 Wakeham et al 12 reported a variation of pre-tracheostomy ventilation ranging from 4.3 days to 30.4 days.…”

Section: Resultsmentioning

confidence: 99%

“…Bypassing the upper airway with a tracheostomy decreases the work of breathing, which may in turn aid a patient with neurological or muscular disease or one experiencing difficulty in weaning. 6 Subsequently, earlier weaning can increase patient comfort, facilitate earlier ambulation and mobilization, improve tracheal toilette, oral feeding and rehabilitation and overall better quality of life for the patient 5,6,11 while earlier hospital discharge can possibly reduce nosocomial infection. 6 Our study has several limitations.…”

Section: Resultsmentioning

confidence: 99%

“…1,2 For adults, it is generally recommended that patients who are on mechanical ventilation or expected to be on mechanical ventilation for > 2 weeks undergo tracheostomy. 3 For pediatric patients, to the best of our knowledge, it seems there is currently no consensus as to when to perform tracheostomy 4,5 although it is claimed that children can tolerate intubation for longer period than adults. 6 A current institutional guideline 7 recommends a safe period of 30 to 60 days intubation before considering elective tracheostomy in pediatric patients more than 1 year old.…”

Section: Original Articlesmentioning

confidence: 99%

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

Ferrolino

Lapeña

Carrillo

2019

Philipp J Otolaryngol Head Neck Surg

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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

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Section: Resultsmentioning

confidence: 61%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Original Articlesmentioning

confidence: 99%

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

Ferrolino

Lapeña

Carrillo

2019

Philipp J Otolaryngol Head Neck Surg

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“…(8) 73 çocuk hasta ile yaptıkları çalışmada erken trakeotominin (14 gün) yoğun bakım yatış gününü ve mekanik ventilatörde kalma süresini kısalttığını ancak mortaliteyi etkilemediğini ifade etmiştir. Benzer şekilde Lee ve ark (14). erken trakeotominin (14 gün) mortalite üzerinde etkili olmadığını ancak yoğunbakım yatış süresini ve ventilatör ilişkili pnomoni sıklığını azalttığını belirtmiştir.…”

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The Evaluation of Tracheotomy Cases in the Pediatric Intensive Care Unit: The Results of Decanulation and Weaning from Mechanical Ventilator

Dursun¹,

Tekerek²,

Akyıldız³

2017

Turkish J Pediatr Dis

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ÖzETAmaç: Hastaların sedasyon ihtiyacını azaltması, pulmoner sekresyonların temizliğinin daha etkin yapılabilmesi, yoğun-bakım yatış gün sayısı üzerine olan olumlu katkılarından dolayı trakeotomi çocuk yoğunbakım uzmanlarının sıkça başvur-duğu bir cerrahi prosedür haline gelmiştir. Daha önce trakeotomi endikasyonları, zamanlaması ve komplikasyonları gibi konularla ilgili bir çok çalışma yapılmış olmasına rağmen mekanik ventilatörden ayrılma ve dekanülasyon ile ilgili bilgiler sınırlıdır. Bu çalışmada trakeotomi sonrası mekanik ventilatörden ayrılma ve dekanülasyon sonuçlarınının değerlendiril-mesi amaçlanmıştır. ABSTRAcTObjective: Tracheostomy has become a frequent surgical procedure for pediatric intensivists asit reduces the patient's sedation needs and the length of the Pediatric Intensive Care Unit (PICU) stay and also improves the efficiency of pulmonary secretion clearance. Despite previous studies on tracheostomy indications, timing and complications, there is limited information on extubation success and decanulation. In this study, we aimed to present the decanulation and weaning from mechanical ventilator results after tracheostomy. Material and Methods: This study was carried out retrospectively from the records of patients who underwent tracheostomy between January 2010 and August 2016 at the Erciyes University Medical Faculty Pediatric Intensive Care Unit. Results: A total of 107 patients were included in this study. There were 55 (51.4%) males and 52 (48.6%) females. The median age of the patients was 23 (10-79) months and the duration of mechanical ventilation before tracheostomy was 23 (17-30) days. The most common indication was long-term ventilation (81.3%), followed by airway abstruction (14%), and pulmonary toilet (4.7%). Sixty five were weaned from the mechanical ventilator and 28% of the patients were decannulated. The ET group PICU stay was 23 (15-32) days, and the LT group PICU stay was 52 (40-79) days (p<0.01). There was no significant difference in mortality between the two groups (p=0.786). conclusion: Tracheostomy is a good choice in terms of alleviating the chronic patient burden in our country where there is limited pediatric intensive care capacity

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The “Surgeon on Service” Model for Timely, Economically Viable Inpatient Care of Tracheostomy Patients in Academic Pediatric Otolaryngology

Lavin

Schroeder

Thompson

2017

JAMA Otolaryngol Head Neck Surg

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Effect of early vs. late tracheostomy on clinical outcomes in critically ill pediatric patients

Abstract: Tracheostomy performed within 14 days after the initiation of MV was associated with reduced duration of MV and length of ICU and hospital stay. Although there was no effect on mortality rate, children may benefit from early tracheostomy without severe complications.

Cited by 23 publications

References 27 publications

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

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

The Evaluation of Tracheotomy Cases in the Pediatric Intensive Care Unit: The Results of Decanulation and Weaning from Mechanical Ventilator

The “Surgeon on Service” Model for Timely, Economically Viable Inpatient Care of Tracheostomy Patients in Academic Pediatric Otolaryngology

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