Use of tracheostomy in the PICU among patients requiring prolonged mechanical ventilation

Koo

Acta Anaesthesiol Scand

et al. 2016

Section: Discussionsupporting

confidence: 92%

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

Koo

Acta Anaesthesiol Scand

et al. 2016

Pediatric Critical Care Medicine

“…A study of United Kingdom PICUs found a 2% incidence of tracheostomy; institutional incidence varied from 0.13 to 5.66% (12). Wakeham et al studied tracheostomies in children in PICUs who required mechanical ventilation for ≥3 days (13). They found 6.6% of these patients received a tracheostomy (48% of whom were also discharged on mechanical ventilator support) and significant variation in the use and timing of tracheostomy across units.…”

Section: Discussionmentioning

confidence: 99%

Children and Young Adults Who Received Tracheostomies or Were Initiated on Long-Term Ventilation in PICUs*

Edwards

Houtrow

Lucas

et al. 2016

Objectives To characterize patients who received tracheostomies for airway compromise or were initiated on long-term ventilation for chronic respiratory failure in pediatric intensive care units (PICU), and to examine variation in the incidence of initiation, patient characteristics, and modalities across sites. Design Retrospective cross-sectional analysis. Settings Seventy three North American PICUs that participated in the Virtual Pediatric Intensive Care Unit Performance System. Patients PICU patients admitted between 2009 and 2011. Interventions None. Measurements and Main Results Among 115,437 PICU patients, 1.8% received a tracheostomy or were initiated on long-term ventilation; 1034 received a tracheostomy only, 717 were initiated on invasive ventilation (IV), and 381 were initiated on noninvasive ventilation (NIV). Ninety percent had substantial chronic conditions and comorbidities, including more than 50% with moderate or worse cerebral disability upon discharge. Seven percent were initiated after a catastrophic injury/event. Across sites, there was variation in incidence of tracheotomy and initiation of long-term ventilation, ranging 0–4.6%. There also was variation in patient characteristics, time to tracheotomy, number of extubations prior to tracheostomy, and the use of IV versus NIV. Conclusions While the PICU incidence of initiation of tracheostomies and long-term ventilation was relatively uncommon, it suggests that thousands of children and young adults receive these interventions each year in North American PICUs. The majority of them have conditions and comorbidities that impose on-going care needs, beyond those required by artificial airways and long-term ventilation themselves.

Pediatric Blood & Cancer

“…As increasing number of high‐grade malignancies are successfully treated with intensive chemotherapy, we envisage that more children will require prolonged ventilatory support during intensive chemotherapy. A recent series indicates tracheostomy rate of 10% in children with a cancer diagnosis who were ventilated for more than 72 h, which is higher than 6% in our cohort. However, tracheostomy in children with high‐risk cancers should be considered carefully as decision for limitation of care may be challenging practically, ethically and emotionally, if the disease progresses with no possibility of a cure or control of disease.…”

Section: Discussionmentioning

confidence: 99%

“…Surgical tracheostomy in children is associated with high incidence (18‐50%) of complications including dislodgement, obstruction, haemorrhage, infection, granuloma formation, and emphysema . It is infrequently performed in Paediatric Intensive Care Unit (PICU) patients compared to adults due to clinicians’ worry about complications associated with the procedure .…”

Section: Introductionmentioning

confidence: 99%

Surgical tracheostomy in children with malignancy receiving intensive chemotherapy: A case series and review of literature

Manna¹,

Malik²,

Douthwaite³

et al. 2019

We retrospectively reviewed a paediatric intensive care unit database that supports a tertiary oncology service to explore safety and outcome of tracheostomy in oncology patients over a 12‐year period and reviewed literature. A total of 895 patients were admitted with a haematological or a solid tumour malignancy of which 222 were ventilated. Six of 222 (2.7%) ventilated children were tracheostomised. Four of six children tracheostomised for ventilatory support received intensive chemotherapy complicated by neutropenia and thrombocytopenia. There was no significant tracheostomy‐related complication. Tracheostomy improved patient comfort, reduced sedative requirement, and may have helped recovery. Tracheostomy should be considered early in selected children with haemato‐oncological diagnoses requiring prolonged ventilation.