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

Araújo, Orlei Ribeiro de; Azevedo, Ramiro Anthero de; Oliveira, Felipe Rezende Caino de; Colleti, José

doi:10.1016/j.jped.2021.07.004

Cited by 11 publications

(7 citation statements)

References 75 publications

(132 reference statements)

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“…Our patient demographics and clinical characteristics were similar to the cohorts in other pediatric tracheostomy studies. Majority of our patients had complex chronic disease (95%, 9,823/10,295), similar to smaller reported pediatric cohorts (19, 21–23). This reemphasizes the changing landscape of tracheostomy over the past few decades, from an emergency procedure during the diphtheria epidemic to a life-sustaining therapy for pediatric patients with medical complexity and resultant respiratory failure (3, 24–26).…”

Section: Discussionsupporting

confidence: 88%

“…Our study demonstrates that ET is associated with significantly lower mortality, LOS, hospital costs, and HAP after adjusting for demographic and clinical characteristics as potential confounders. A pediatric tracheostomy review and meta-analysis conducted in 2018 with 649 patients stated that ET was associated with significant reductions in mortality, days on MV, and LOS (10), while a more recent review in 2021 with 783 patients stated that ET was associated with significant reductions in days on MV and LOS with no effect on mortality (23). Previous pediatric studies, most retrospective in design, have demonstrated that patients with ET have decreased hospital and ICU LOS (16, 27) and decreased rates of HAP (19, 28, 29).…”

Section: Discussionmentioning

confidence: 99%

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Timing of Tracheostomy in Critically Ill Infants and Children With Respiratory Failure: A Pediatric Health Information System Study

Mehrotra

Thomas

Gerber

et al. 2023

Pediatric Critical Care Medicine

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OBJECTIVES:Tracheostomy placement in infants and children with respiratory failure has steadily increased over time, yet there is no consensus for optimal timing. We sought to: 1) describe tracheostomy timing and associated demographic and clinical characteristics in a large ICU cohort and 2) compare clinical outcomes between subgroups based on tracheostomy timing. DESIGN:Retrospective observational study using the Pediatric Health Information System (PHIS). SETTING: Neonatal ICUs and PICUs in the United States.PATIENTS: PHIS was queried for patients less than 18 years who underwent tracheostomy from 2010 to 2020. Patients were included if admitted to an ICU with need for mechanical ventilation (MV) prior to tracheostomy in the same hospitalization. Patients were categorized as early tracheostomy (ET) (placement at MV day ≤ 14), late tracheostomy (LT) (MV days 15-60), and extended tracheostomy (ExT) (MV day > 60). Primary endpoints included demographic and clinical characteristics. Secondary endpoints included patient outcomes: in-hospital mortality, length of stay (LOS), hospital-acquired pneumonia (HAP), and hospital costs. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS:Sixteen thousand one hundred twenty-one patients underwent tracheostomy at 52 children's hospitals. Ten thousand two hundred ninety-five had complete data and were included in the analysis. Thirty-nine percent (4,006/10,295) underwent ET, 40% (4,159/10,295) underwent LT, and 21% (2,130/10,295) underwent ExT. Majority of patients in all subgroups had complex chronic conditions. Median age was significantly different between subgroups with ET being the oldest (p < 0.001). A multivariable regression analysis showed that ET was associated with lower in-hospital mortality (p < 0.001), shorter hospital LOS (p < 0.001), shorter ICU LOS (p < 0.001), shorter post-tracheostomy LOS (p < 0.001), decreased HAP (p < 0.001), and lower hospital costs (p < 0.001) compared with those who underwent LT or ExT. CONCLUSIONS:In a large cohort of pediatric patients with respiratory failure, tracheostomy placement within 14 days of MV was associated with improved inhospital outcomes. ET was independently associated with decreased mortality, LOS, HAP, and hospital costs.

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Section: Discussionsupporting

confidence: 88%

Section: Discussionmentioning

confidence: 99%

Timing of Tracheostomy in Critically Ill Infants and Children With Respiratory Failure: A Pediatric Health Information System Study

Mehrotra

Thomas

Gerber

et al. 2023

Pediatric Critical Care Medicine

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“…Although it was recommended for adult patients that tracheostomy should be performed within 1–2 weeks of ventilation, no consensus criteria of time to tracheostomy exists for children ( 32 , 37 ). Some studies reported that early tracheostomy (within 14 days of ventilation) could reduce MV duration and hospital LOS ( 38 , 39 ). From another point of view, caregivers of children with tracheostomy tubes have high caregiver workloads and financial burden ( 40 , 41 ).…”

Section: Discussionmentioning

confidence: 99%

Epidemiology, risk factors and outcomes of prolonged mechanical ventilation with different cut-points in a PICU

2023

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BackgroundA consensus on the definition of prolonged mechanical ventilation (PMV) for children does not exist. There is still lack of published work presenting the epidemiology, risk factors and outcomes at different cut-points for PMV patients. These are important for planning the goals of treatment and counseling of the prognosis for patient families. We aimed to determine the incidence, baseline characteristics, risk factors and outcomes of PMV in pediatric patients at various cut-points (>14, >21 or >30days).MethodsA retrospective cohort study among children <18-years-old who were PMV > 14 days in the PICU of King Chulalongkorn Memorial Hospital was conducted. The primary outcomes were incidence of PMV with various cut-points. We stratified patients into three groups (Group 1; PMV > 14–21, Group 2; >21–30, Group 3; >30 days) for evaluating the baseline characteristics, risk factors, and outcomes of PMV (extubation success, tracheostomy status and death). Factors associated with PMV and deaths were analyzed using univariate and multivariate logistic regression.ResultsFrom January 2018 to August 2022, 1,050 patients were screened. Of these, 114 patients were enrolled. The incidence of PMV > 14, >21 and >30 days were 10.9%, 7.3% and 5.0% respectively. Extubation success was significantly lower in Group 3 than in Groups 1 & 2 (15.4% vs. 62.2% & 56.0%, P < 0.001). Consequently, the tracheostomy rate (63.5% vs. 16.2% & 12.0%, P < 0.001), VAP rate (98.1% vs. 59.5% & 80.0%, P < 0.001), mortality rate by disease (34.6% vs. 5.4% & 20.0%, P = 0.003), median PICU LOS (50.5 vs. 22.0 & 28.0 days, P < 0.001) and median hospital LOS (124.5 vs. 55.0 & 62.0 days, P < 0.001) were also significantly higher for Group 3 compared with Groups 1 & 2. The factor associated with PMV > 30 days was VAP (aOR: 19.53, 95% CI: 2.38–160.34, P = 0.01). Factors associated with non-surviving patients were 3rd degree PEM (aOR: 5.14, 95% CI: 1.57–16.88, P = 0.01), PIM3 score ≥14 (aOR: 6.75, 95% CI: 2.26–20.15, P < 0.001) and muscle relaxant usage (aOR: 5.58, 95% CI: 1.65–18.86, P = 0.01).ConclusionExtubation failure, tracheostomy rate, VAP rate, mortality rate by disease, PICU LOS and hospital LOS were significantly higher for PMV >30 days. Consequently, we suggest that a 30-day duration as a cut-point for PMV in PICUs might be more appropriate.

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“…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.…”

Section: Introductionunclassified

Traqueostomía en Prematuros Con Displasia Broncopulmonar Grave

Recondo¹

2023

Neumol Pediatr

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Los recién nacidos con displasia broncopulmonar dependientes de ventilación mecánica a las 36 semanas, corresponden en general a prematuros menores de 27 semanas con morbilidad grave: enterocolitis, infecciones, retinopatía, retraso en el crecimiento y secuelas del neurodesarrollo. Si la extubación no es posible entre las 40 y 50 semanas, se indica una traqueostomía, normalmente acompañada de una gastrostomía. La decisión depende del apoyo ventilatorio, de la morbilidad asociada (neurológica, hipertensión pulmonar, lesiones de la vía aérea) y del grado de desnutrición. La traqueostomía optimiza el manejo ventilatorio, disminuye la necesidad de sedación, facilita la movilidad, la neurorrehabilitación y el alta al hogar en ventilación domiciliaria. La edad óptima de ejecución no está estandarizada, pero hay evidencia que muestra beneficios en el neurodesarrollo si se realiza antes de los 120 días de vida. La mayoría de los prematuros traqueostomizados son manejados en domicilio y a los 5 años ya se encuentran decanulados.

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

Cited by 11 publications

References 75 publications

Timing of Tracheostomy in Critically Ill Infants and Children With Respiratory Failure: A Pediatric Health Information System Study

Timing of Tracheostomy in Critically Ill Infants and Children With Respiratory Failure: A Pediatric Health Information System Study

Epidemiology, risk factors and outcomes of prolonged mechanical ventilation with different cut-points in a PICU

Traqueostomía en Prematuros Con Displasia Broncopulmonar Grave

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