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Tracheostomy in children admitted to paediatric intensive care
  1. Dora Wood1,
  2. Philip McShane2,
  3. Peter Davis1
  1. 1Paediatric Intensive Care Unit, Bristol Royal Hospital for Children, Bristol, UK
  2. 2Paediatric Epidemiology Group, University of Leeds, Leeds, UK
  1. Correspondence to Dora Wood, Bristol Royal Hospital for Children, Paediatric Intensive Care Unit, Upper Maudlin Street, Bristol, Avon BS2 8BJ, UK; dora{at}doctors.net.uk

Abstract

Purpose Tracheostomy is a common intervention for adults admitted to intensive care; many are performed early and most are percutaneous. Our study aimed to elucidate current practice and indications for children in the UK admitted to paediatric intensive care and undergoing tracheostomy.

Design A questionnaire covering unit guidelines, practice, and the advantages and disadvantages of tracheostomy was sent to all UK paediatric intensive care units (PICUs) participating in the Paediatric Intensive Care Audit Network (PICANet). These results were combined with data from PICANet on all children in the UK reported to have had a tracheostomy performed during a PICU admission between 2005 and 2009 inclusive.

Results Over 5 years, 1613 children had tracheostomies performed during their PICU admission (2.05% of all admissions). The death rate was 5.58% with tracheostomy versus 4.72% overall, but differences were not significant when risk-adjusted using the Paediatric Index of Mortality 2 (PIM2). All 29 units participating in PICANet responded to the survey. Prolonged invasive ventilation was an indication for tracheostomy in 25/29 units, but the definition varied between 14 and 90 days, and most respondents considered timing on an individual basis. Children undergoing tracheostomy during PICU admission account for 9% of PICU bed days in the UK.

Conclusions In contrast with current adult UK practice, tracheostomy for children admitted to intensive care is infrequent, performed late following admission and usually surgical. Practice varies significantly. The death rate for children having a tracheostomy performed was not significantly higher than for children admitted to PICU who did not undergo tracheostomy.

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Footnotes

  • Funding PICANet is funded by the National Clinical Audit and Patient Outcomes Programme via the Healthcare Quality Improvement Partnership (HQIP), Health Commission Wales Specialised Services, NHS Lothian/National Service Division NHS Scotland, the Royal Belfast Hospital for Sick Children, Our Lady's Children's Hospital, Dublin, Children's University Hospital, Dublin and The Harley Street Clinic, London.

  • Competing interests None.

  • Ethics approval PICANet has research MREC ethics committee approval (05/MRE04/17) and National Information Governance Board (4-07(c)/2002-PICANet) approvals to collect patient identifiable data without informed consent.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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