Children and young adults who received tracheostomies or were initiated on long-term ventilation in PICUs

Edwards, Jeffrey David; Houtrow, Amy J.; Lucas, Adam R.; Miller, Rachel L.; Keens, Thomas G.; Panitch, Howard B.; Dudley, R. Adams

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.


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Pediatric Critical Care Medicine

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May 9, 2017