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Abstract

Introduction: Tracheostomy is a relatively common procedure among critically ill adults; it is reported to be performed in 8-24% of adults requiring mechanical ventilation (MV). Two recent studies of this patient population reported the median time from initiation of MV to tracheostomy to be 11 and 12 days. Much less is known about the use of tracheostomy among pediatric patients requiring MV in the pediatric intensive care unit (PICU). Hypothesis: The objective of this study was to describe the frequency and timing of tracheostomy among PICU patients requiring prolonged MV (defined as MV for at least 3 days). Methods: This was a retrospective cohort study. De-identified data was obtained from the VPSLLC database, a multi-site, clinical PICU database. PICU admissions between July 1st 2009 and June 30 2011 from centers collecting all the required data fields were enrolled in the study if the patient required MV for at least 72hrs and did not have a tracheostomy tube at initiation of MV. 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 at some time after initiation of MV and during their PICU stay. The median age of patients undergoing placement of a tracheostomy tube was 34.06 months (IQR 7.37-142.99) vs. 11.77 months (IQR 2.13-80.31) for those who did not undergo tracheostomy. The most common diagnostic categories of patients receiving a tracheostomy were respiratory (40.1%), cardiovascular (14.7%), poisoning/injury (12.2%), and neurological (10.7%). The median total time of MV was 24.09 days (IQR 13.67-46.43) for those who had a tracheostomy tube vs. 6.92 days (IQR 4.65-11.83) for those not having one. Among the ones who had a tracheostomy tube, the median time between initiation of MV and insertion of a tracheostomy tube was 14.29 days (IQR 5.74-25.67); 281 (32%) were on MV upon discharge from the PICU, and 66 (8%) had the tracheostomy tube removed prior to PICU discharge. Conclusions: Less than 10% of PICU patients requiring long term MV received a tracheostomy during their PICU admission; among those who received a tracheostomy, the majority did so after 2 or more weeks of MV.