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

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Abstract

Purpose

The purpose of the present study is to describe the use of tracheostomy, specifically frequency, timing (in relation to initiation of mechanical ventilation), and associated factors, in a large cohort of children admitted to North American pediatric intensive care units (PICUs) and requiring prolonged mechanical ventilation.

Methods

This was a retrospective cohort study. De-identified data were obtained from the VPSLLC database, a multi-site, clinical PICU database. Admissions between 1 July 2009 and 30 June 2011 were enrolled in the study if the patient required mechanical ventilation for at least 72 h and did not have a tracheostomy tube at initiation of mechanical ventilation.

Results

A total of 13,232 PICU admissions from 82 PICUs were analyzed in the study; of these, 872 (6.6 %) had a tracheostomy tube inserted after initiation of mechanical ventilation. The rate varied significantly (0–13.4 %, p < 0.001) among the 45 PICUs that had 100 or more admissions included in the study. The median time to insertion of a tracheostomy tube was 14.4 days (IQR 7.4–25.7), and it also varied significantly by unit (4.3–30.4 days, p < 0.001) among those that performed at least ten tracheostomies included in the study.

Conclusions

There is significant variation in both the frequency and time to tracheostomy between the studied PICUs for patients requiring prolonged mechanical ventilation; among those who received a tracheostomy, the majority did so after two or more weeks of mechanical ventilation. Future studies examining tracheostomy benefits, disadvantages, outcomes, and resource utilization of this patient subgroup are indicated.

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Acknowledgments

VPS data was provided by the VPSLLC. No endorsement or editorial restriction of the interpretation of these data or opinions of the authors has been implied or stated. The authors have no financial relationships relevant to this article to disclose. The only potential financial relationship is the clinical consultation that Dr. Scanlon has performed in the development of the VPS database. Dr. Scanlon, a salaried employee of the non-profit Medical College of Wisconsin, received no direct compensation for his work. The Medical College of Wisconsin was directly compensated for Dr. Scanlon’s efforts by the VPSLLC.

Conflicts of interest

The authors have no conflicts of interest to disclose.

Author information

Authors and Affiliations

  1. Division of Pediatric Critical Care, Medical College of Wisconsin, 9000 W Wisconsin Ave, MS 681, Milwaukee, WI, 53226, USA

    Martin K. Wakeham, K. Jane Lee & Matthew C. Scanlon

  2. National Outcomes Center, Children’s Hospital of Wisconsin, 999 North 92nd Street, Suite C640, Milwaukee, WI, 53226, USA

    Evelyn M. Kuhn

  3. Division of Pediatric Critical Care, Wake Forest University School of Medicine, Medical Center Boulevard, Winston Salem, NC, 27157, USA

    Michael C. McCrory

Authors
  1. Martin K. Wakeham
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  2. Evelyn M. Kuhn
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  3. K. Jane Lee
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  4. Michael C. McCrory
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  5. Matthew C. Scanlon
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Corresponding author

Correspondence to Martin K. Wakeham.

Additional information

Take-home message: Demographic and clinical characteristics are associated with the frequency and timing of tracheostomy among PICU patients requiring prolonged mechanical ventilation. Independent of these characteristics, there is significant variation among the studied PICUs. These findings are important because decreasing non-value-added variability of practice represents a potential opportunity for quality improvement; however, in order to drive the direction of such efforts, studies examining tracheostomy benefits, disadvantages, and outcomes, including quality of life and resource utilization of this patient subgroup, are needed.

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Wakeham, M.K., Kuhn, E.M., Lee, K.J. et al. Use of tracheostomy in the PICU among patients requiring prolonged mechanical ventilation. Intensive Care Med 40, 863–870 (2014). https://doi.org/10.1007/s00134-014-3298-4

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  • DOI: https://doi.org/10.1007/s00134-014-3298-4

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