title: Outcomes of tracheostomy following congenital heart surgery: a contemporary experience.
abstract: BACKGROUND
  Following congenital heart surgery, pediatric patients may experience persistent respiratory failure that requires tracheostomy placement. Currently, definitive knowledge of the optimal timing for tracheostomy placement in this patient population is lacking.
  
  
  METHODS
  An 8-year retrospective review of 17 pediatric patients who underwent congenital heart surgery and subsequently required tracheostomy placement was performed. Patients were evaluated with regard to the timing of tracheostomy and mortality.
  
  
  RESULTS
  The overall study mortality was 24%. The median duration of intubation prior to tracheostomy was 60 days (interquartile range: 19-90 days); there was no difference in the average time between intubation and tracheostomy for survivors compared with nonsurvivors (51 vs. 73 days, P = .37). No difference was observed in the overall duration of positive pressure ventilation when tracheostomy was performed within 30 days of intubation compared with greater than 30 days following intubation (481 vs. 451 days, P = .88). Overall, 18% of patients were successfully weaned from the ventilator after a median duration of positive pressure ventilation of 212 days.
  
  
  CONCLUSIONS
  The timing of tracheostomy placement may be an important factor in clinical outcomes for pediatric patients with persistent dependence on mechanical ventilatory support following congenital heart surgery. A larger, multi-institution study may help further elucidate our observed clinical findings in this patient population.
authors.affiliation: Division of Cardiovascular Surgery, Children's National Health System, Washington, DC, USA; The Sheikh Zayed Institute for Pediatric Surgical Innovation, Children's National Health System, Washington, DC, USA.
authors.forename: John P
authors.initials: JP
authors.lastname: Costello
authors.forename: Dominic A
authors.initials: DA
authors.lastname: Emerson
authors.forename: Michael K
authors.initials: MK
authors.lastname: Shu
authors.forename: Syed M
authors.initials: SM
authors.lastname: Peer
authors.forename: David
authors.initials: D
authors.lastname: Zurakowski
authors.forename: Brian K
authors.initials: BK
authors.lastname: Reilly
authors.forename: Darren
authors.initials: D
authors.lastname: Klugman
authors.forename: Richard A
authors.initials: RA
authors.lastname: Jonas
authors.forename: Dilip S
authors.initials: DS
authors.lastname: Nath
mesh_terms: D000367:Age Factors; D006348:Cardiac Surgical Procedures / Q000009:adverse effects* / Q000401:mortality; D005260:Female; D006330:Heart Defects, Congenital / Q000175:diagnosis / Q000401:mortality / Q000601:surgery*; D017052:Hospital Mortality; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D007442:Intubation, Intratracheal; D008297:Male; D011175:Positive-Pressure Respiration; D012131:Respiratory Insufficiency / Q000175:diagnosis / Q000209:etiology / Q000401:mortality / Q000628:therapy*; D012189:Retrospective Studies; D012307:Risk Factors; D013997:Time Factors; D061665:Time-to-Treatment; D014139:Tracheostomy / Q000009:adverse effects / Q000401:mortality; D016896:Treatment Outcome
keywords: Congenital Heart Surgery; Critical Care; Mechanical Ventilation; Tracheostomy