Safety of pediatric bedside tracheostomy in the intensive care unit.
BACKGROUND
Elective bedside pediatric tracheostomies in the intensive care unit have not been widely reported. Unlike in the adult population, this is not yet considered a safe or routine procedure in the pediatric population. We performed a preliminary study suggesting that bedside pediatric tracheostomies can be done safely and at reduced cost.


METHODS
Retrospective medical chart review.


METHODS
Tertiary care referral center at a single university hospital.


METHODS
Fifty-seven patients, ranging in age from 15 days to 8 years. Thirty operating room tracheostomies and 27 bedside tracheostomies were performed during a 6-year period. The mean age of the patients was 20.5 months, with no significant age difference between the 2 groups. The top 3 diagnoses necessitating tracheostomy were laryngotracheal disorders (18 patients [32%]), bronchopulmonary dysplasia (9 [16%]), and neurologic disorders (6 [11%]).


METHODS
Tracheostomy.


METHODS
The initial 48-hour postoperative period was examined to compare complication rates between groups.


RESULTS
Overall, the 2 groups had similar complication rates (chi(2) = 0.12; P =.73). The operating room group had 3 complications (10%) related to bleeding, infection, and pneumothorax. The bedside group had 2 complications (7%), both involving pneumothorax. Each operating room tracheostomy incurred charges totaling $1693 vs $235 for each bedside tracheostomy.


CONCLUSIONS
Historically, pediatric tracheostomy has been viewed as a technically demanding procedure with a high complication rate, thus encouraging routine operating room use. We found that pediatric tracheostomy performed in the intensive care unit, with attention to prudent patient selection and adherence to consistent, sound techniques, was as safe as operating room tracheostomy.
Klotz
D A
DA
Division of Otolaryngology-Head and Neck Surgery, Department of Surgery, University of Rochester Medical Center, Rochester, NY, USA.
Hengerer
A S
AS
D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D015278:Intensive Care Units, Pediatric; D008297:Male; D009873:Operating Rooms; D019095:Point-of-Care Systems; D012189:Retrospective Studies; D012449:Safety; D014139:Tracheostomy / Q000009:adverse effects