title: Association of timing of tracheostomy on clinical outcomes in PICU patients.
abstract: OBJECTIVE
  Tracheostomy is a common procedure in the ICU when prolonged mechanical ventilation is expected. Although adult data show morbidity and mortality benefits over translaryngeal intubation, there is no consensus on optimal timing. In the pediatric population, there is sparse data regarding morbidities associated with duration of ventilation prior to tracheostomy. Our objective was to associate timing of tracheostomy with clinical outcomes in PICU patients.
  
  
  METHODS
  This is a retrospective cohort study of patients undergoing tracheostomy. Patient factors and duration of ventilation prior to tracheostomy were collected on each patient. Morbidities such as ventilator-associated pneumonia, central catheter-associated bloodstream infection, and cardiopulmonary arrests were examined both pre- and posttracheostomy. ICU and total hospital length of stay as well as mortality were recorded. For data analysis regarding tracheostomy timing, patients were stratified into early and late groups using a cutoff of 14 days.
  
  
  METHODS
  The PICUs and cardiac ICUs in a quaternary-care children's hospital.
  
  
  METHODS
  All patients undergoing tracheostomy over a 3-year period.
  
  
  RESULTS
  Seventy-three patients were analyzed with a median of 22 days of ventilation prior to tracheostomy. Patient factors associated with longer pretracheostomy ventilation included congenital heart disease and vasoactive drug use. Clinical events associated with longer pretracheostomy ventilation included bloodstream infection, ventilator-associated pneumonia, and cardiac arrest. Age, congenital heart disease, vasoactive drug use, bloodstream infection, and ventilator-associated pneumonia each independently increased pretracheostomy ventilator days. Median ICU length of stay after tracheostomy was 18 days. For each pretracheostomy ventilator day, ICU length of stay increased by 0.5 days and hospital length of stay increased by 1.9 days. For patients undergoing early tracheostomy, ICU and total hospital lengths of stay were 4 days and 4 weeks shorter, respectively.
  
  
  CONCLUSIONS
  Analysis of our results suggests that a longer duration of ventilation prior to tracheostomy is associated with increased ICU morbidities and length of stay. Early tracheostomy may have significant benefits without adversely affecting mortality.
authors.affiliation: 1Department of Pediatric Critical Care Medicine, University of Maryland Medical Center, Baltimore, MD. 2Department of Pediatric Critical Care Medicine, Children's Hospital of The Kings Daughters Health System, Norfolk, VA. 3Department of Critical Care Medicine, Children's National Health System, George Washington University, Washington, DC.
authors.forename: Adrian J
authors.initials: AJ
authors.lastname: Holloway
authors.forename: Michael C
authors.initials: MC
authors.lastname: Spaeder
authors.forename: Sonali
authors.initials: S
authors.lastname: Basu
mesh_terms: D002648:Child; D002675:Child, Preschool; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D007223:Infant; D007362:Intensive Care Units / Q000706:statistics & numerical data*; D007902:Length of Stay / Q000706:statistics & numerical data*; D008297:Male; D012121:Respiration, Artificial / Q000009:adverse effects / Q000401:mortality* / Q000706:statistics & numerical data; D012189:Retrospective Studies; D013997:Time Factors; D014139:Tracheostomy / Q000009:adverse effects* / Q000401:mortality* / Q000706:statistics & numerical data; D016896:Treatment Outcome