Outcome of patients requiring tracheostomy in a pediatric intensive care unit.
BACKGROUND
Although tracheostomy is a commonly performed procedure, there is a lack of studies in the pediatric intensive care unit (PICU) setting that describe its association with patient outcome and especially hospital mortality. Our goal was to evaluate the outcome of patients receiving a tracheostomy, while on mechanical ventilation (MV), in a PICU.


METHODS
Records of 260 children were reviewed retrospectively regarding PICU mortality, PICU length of stay (PICU LOS), duration of MV and a cost indicator (weighted hospital days; WHD).


RESULTS
Nineteen patients received tracheostomy (7.3%). The mortality of patients submitted to tracheostomy in the longer term was significantly higher compared to patients who were not (52.6%vs. 27.6%; P = 0.04) despite having a significantly lower severity of illness at admission (Pediatric Risk of Mortality score--PRISM) (10.9 vs. 13.7; P < 0.001). The mortality of patients without tracheostomy, however, was significantly higher within 30 days (24.8%vs. 5.2%, P < 0.001). Tracheostomized patients had significantly higher mean PICU LOS (68 days vs. 8 days; P < 0.001), duration of MV (62 days vs. 4 days; P < 0.001) and higher WHD (171.5 vs. 21.5; P < 0.001).


CONCLUSIONS
Contrary to findings in critically ill adult patients, ventilated children receiving a tracheostomy had less favorable outcomes compared with non-tracheostomized patients. In view of the greater use of resources, further studies are needed to confirm and to identify the subgroups of mechanically ventilated patients who will benefit most from this procedure.
Da Silva
Paulo Sérgio Lucas
PS
The Pediatric Intensive Care Unit, Hospital do Servidor Público Municipal, São Paulo, Brazil. psls.nat@terra.com.br
Waisberg
Jaques
J
Paulo
Chiu Seing Tsok
CS
Colugnati
Fernando
F
Martins
Lourdes Conceição
LC
D002648:Child; D002675:Child, Preschool; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D015278:Intensive Care Units, Pediatric; D007902:Length of Stay; D008297:Male; D012121:Respiration, Artificial; D012189:Retrospective Studies; D013997:Time Factors; D014139:Tracheostomy; D016896:Treatment Outcome