Aims Tracheostomy is a common intervention in adult intensive care. Many are performed early and most are percutaneous.1 A recent study found mortality of 8% after tracheostomy in hospitalised children.2 There are no published guidelines and few studies on tracheostomy specifically in the Paediatric Intensive Care Unit (PICU). Our study aimed to elucidate current practice in the UK.
Methods A survey was sent to lead clinicians of all units participating in Paediatric Intensive Care Audit Network (PICANet). The results were combined with data obtained from PICANet.
Results Over 5 years, 1613 children admitted to PICU had tracheostomies performed (2.05%). Rates varied between units from 0.13% to 5.66% but did not change over time or vary with age or gender of child. Mortality was 5.58% with tracheostomy versus 4.72% overall, but differences were not significant when corrected for Paediatric Index of Mortality score. Compared to all admissions, children who had tracheostomies stayed in PICU longer (mean 24.7 vs 5.7 days, median 9 vs 3 days) with 21.2% (vs 2%) staying for more than 28 days. They used 9.0% bed days over this period. Almost half of children requiring tracheostomy had a previous admission to an intensive care environment (PICU/NICU/ICU). 29/29 units responded to the survey. In all units, most tracheostomies were surgical. In 6, percutaneous tracheostomy was additionally performed on selected adolescents. Prolonged ventilation was an indication in 25 units but the definition varied between 14 and 90 days, and most respondents considered timing on an individual basis. No unit had a lower age or size limit.
Conclusion In contrast with current adult UK practice, tracheostomy in PICU is unusual, performed late, and is usually surgical. Our mortality was lower than previously reported and no higher than in children admitted to PICU who did not undergo tracheostomy. Practice between PICUs varies significantly. With an increasing number of complex children and expectations of more aggressive medical management, there is an urgent need for high quality trial data to guide decisions around tracheostomy in this setting.
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