Summary
Introduction
The purpose of the study was to evaluate the outcomes of pediatric ventilated patients
who underwent early tracheostomy. Our hypothesis is early tracheostomy will be associated
with less ventilator days, Intensive care (ICU) days and hospital days.
Methods
The Trauma Quality Improvement Program (TQIP) database of the calendar year 2017 through
2019 was used for the study. All pediatric trauma patients ≤17 years who were admitted
to the hospital and were placed on mechanical ventilation were included in the study.
Other variables included patients’ demography, Injury Severity Score (ISS), Glasgow
Coma Scale (GCS) score, types of procedure that were performed for hemorrhage control.
Propensity score matching analysis was performed between the early (≤7 days) and late
tracheostomy (>7 days) groups. The primary outcome of the study was total hospital
length of stay. Other outcomes were ICU days, ventilator days.
Results
Propensity score matching created 643 pairs of patients. The median age (years [interquartile
range]) of the patient was 14 [8-16]. Most patients suffered from severe injuries
with a median ISS 29 [22-38] and GCS score was 3 [3-8]. There was no significant difference
identified between the early and the late groups, in hospital stay (24 [23, 26] vs.
24 [23, 26], P=0.5), ICU days (14 [9-22] vs. 16 [9-23], P=0.073) and ventilator days
(10 [6-17] vs. 11 [7-18], P=0.073). The incidence of pneumonia between the groups
was (8.7% vs. 9.2%, P=0.347).
Conclusion
Early tracheostomy failed to show any outcomes benefit in ventilated pediatric trauma
patients.
To read this article in full you will need to make a payment
Purchase one-time access:
Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online accessOne-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:
Subscribe to Journal of Pediatric SurgeryAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
References
- Safety of bedside percutaneous tracheostomy in the critically ill: evaluation of more than 3,000 procedures.J Am Coll Surg. 2013 Apr; 216 (Epub 2013 Feb 8. PMID: 23403139): 858-865https://doi.org/10.1016/j.jamcollsurg.2012.12.017
- Meta-analysis comparison of open versus percutaneous tracheostomy.Laryngoscope. 2007 Mar; 117 (PMID: 17334304): 447-454https://doi.org/10.1097/01.mlg.0000251585.31778.c9
- Practice Management Guidelines for Timing of Tracheostomy: The EAST Practice Management Guidelines Work Group.The Journal of Trauma: Injury, Infection, and Critical Care. 2009 -; 67 (October): 870-874https://doi.org/10.1097/TA.0b013e3181b5a960
- Timing of tracheotomy in ICU patients: a systematic review of randomized controlled trials.Crit Care. 2015 Dec 4; 19 (PMID: 26635016; PMCID: PMC4669624): 424https://doi.org/10.1186/s13054-015-1138-8
- Association of timing of tracheostomy on clinical outcomes in PICU patients.Pediatric Crit Care Med. 2015; 16 (Epub 2015/01/13) (PubMed PMID: 25581633): e52-e58https://doi.org/10.1097/pcc.0000000000000336
- Effect of early vs. late tracheostomy on clinical outcomes in critically ill pediatric patients.Acta Anaesthesiol Scand. 2016; 60 (Epub 2016/07/06) (PubMed PMID: 27377041): 1281-1288https://doi.org/10.1111/aas.12760
- Early Tracheostomy for Severe Pediatric Traumatic Brain Injury is Associated with Reduced Intensive Care Unit Length of Stay and Total Ventilator Days.J Intensive Care Med. 2020 Nov; 35 (Epub 2019 Aug 27. PMID: 31455142): 1346-1351https://doi.org/10.1177/0885066619870153
https://www.facs.org/quality-programs/trauma/quality/trauma-quality-improvement-program/. Accessed date June 28, 2022
- MatchIt: Nonparametric Preprocessing for Parametric Causal Inference.Journal of Statistical Software. 2011; 42 (URL): 1-28
R Core Team (2021). R: A language and environment for statistical computing. R Foundation for Statistical Computing, Vienna, Austria. URL https://www.R-project.org/.
- Early tracheostomy in intensive care trauma patients improves resource utilization: a cohort study and literature review.Crit Care. 2004; 8: R347https://doi.org/10.1186/cc2924
- Early tracheostomy for primary airway management in the surgical critical care setting.Surgery. 1990; 108: 655-659
- Early Tracheostomy in Severe Traumatic Brain Injury Patients: A Meta-Analysis and Comparison With Late Tracheostomy.Critical Care Medicine. 2020; 48: p e325-e331https://doi.org/10.1097/CCM.0000000000004239
Nasim Ahmed and Yen-Hong Kuo. Surgical Infections. Jun 2007.343-348.http://doi.org/10.1089/sur.2006.065
- Early tracheostomy improves outcomes in severely injured children and adolescents.Journal of Pediatric Surgery. 2014; 49 (ISSN 0022-3468): 590-592https://doi.org/10.1016/j.jpedsurg.2013.09.002
- The effect of tracheostomy delay time on outcome of patients with prolonged mechanical ventilation: A STROBE-compliant retrospective cohort study.Medicine (Baltimore). 2019 Aug; 98 (PMID: 31464931; PMCID: PMC6736483)e16939https://doi.org/10.1097/MD.0000000000016939
Article info
Publication history
Accepted:
January 10,
2023
Received in revised form:
December 19,
2022
Received:
October 3,
2022
Publication stage
In Press Accepted ManuscriptIdentification
Copyright
© 2023 Elsevier Inc. All rights reserved.
