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Tracheostomies in paediatric intensive care: evolving indications and changing expectations
  1. Quen Mok
  1. UCL Institute of Child Health, Guilford Street, London WC1N 1EH
  1. Correspondence to Dr Quen Mok, Paediatric and Neonatal Intensive Care Unit, Great Ormond Street Hospital for Children NHS Foundation Trust, Great Ormond Street, London WC1N 3JH, UK; Quen.Mok{at}gosh.nhs.uk

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Percutaneous tracheostomy is a common procedure in adult intensive care units (ICU). This is mostly performed to facilitate ventilation, and it has been shown to reduce length of stay in the ICU, as well as resulting in improved patient comfort. Early tracheostomy in adults is associated with lower mortality than late tracheostomy, and each additional delay of 1 day has been shown to be associated with increased mortality (HR 1.008, 95% CI 1.004 to 1.012).1 In adult ICUs, the tracheostomy tends to be done as early as 72 h if it is likely that the patient will require longer-term ventilation.

There is a lack of evidence to demonstrate the benefit of tracheostomies in children, with only a few single-centre reports from retrospective reviews about the frequency and indications for performing a tracheostomy in the paediatric intensive care unit (PICU) setting. A study to determine the current practice and opinions of paediatric intensivists in Canada reported an 81% response rate and showed that tracheostomy is rarely performed among ventilated children in Canada (rate <1.5%), although 51% of the responders believe that it is underutilised.2 The article by Wood et al in this issue reports on the current practice in PICUs in the UK.3 Tracheostomies are performed at a similar rate in children in the UK (only 2% of all PICU admissions over the 5-year period), and this is performed much less frequently than …

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