title: Predictors of need for mechanical ventilation at discharge after tracheostomy in the PICU.
abstract: BACKGROUND
  The objective of this study was to determine factors predictive of need for mechanical ventilation (MV) upon discharge from the pediatric intensive care unit (PICU) among patients who receive a tracheostomy during their stay.
  
  
  METHODS
  This was a retrospective cohort study using the Virtual PICU Systems (VPS) database. Patients <18 years old admitted between 2009-2011 who required MV for at least 3 days and received a tracheostomy during their PICU stay were included.
  
  
  RESULTS
  A total of 680 pediatric patients from 74 PICUs were included, of whom 347 (51%) remained on MV at the time of PICU discharge. Neonates (30/38, 79%) and infants (129/203, 64%) required MV at PICU discharge after tracheostomy more often than adolescents (66/141, 47%) and children (122/298, 41%). Time on MV pre-tracheostomy was longer among those who required MV at discharge (median 18.3 vs. 13.8 days, P < 0.0001); however, number of failed extubations was similar (median 1 for both groups, P = 0.97). On mixed-effects multivariable regression analysis, the age categories of neonate (OR 2.9, 95%CI 1.1-7.6, P = 0.03), and infant (OR 1.7, 95%CI 1.1-2.8, P = 0.03), and ventilator days prior to tracheostomy (OR 1.01, 95%CI 1.0-1.02, P = 0.01) were significantly associated with increased odds of MV upon PICU discharge, while being a trauma admission was associated with decreased odds (OR 0.45, 95%CI 0.28-0.73, P = 0.001).
  
  
  CONCLUSIONS
  Younger patients and those with prolonged courses of MV prior to tracheostomy are more likely to continue to need MV upon PICU discharge.
authors.affiliation: Section on Pediatric Critical Care Medicine, Department of Anesthesiology, Wake Forest School of Medicine, Winston-Salem, North Carolina.
authors.forename: Michael C
authors.initials: MC
authors.lastname: McCrory
authors.affiliation: Department of Pediatrics, Division of Pediatric Critical Care, Medical College of Wisconsin, Milwaukee, Wisconsin.
authors.forename: K Jane
authors.initials: KJ
authors.lastname: Lee
authors.affiliation: Department of Pediatrics, Division of Pediatric Critical Care, Medical College of Wisconsin, Milwaukee, Wisconsin.
authors.forename: Matthew C
authors.initials: MC
authors.lastname: Scanlon
authors.affiliation: Department of Pediatrics, Division of Pediatric Critical Care, Medical College of Wisconsin, Milwaukee, Wisconsin.
authors.forename: Martin K
authors.initials: MK
authors.lastname: Wakeham
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D016208:Databases, Factual; D005260:Female; D006760:Hospitalization; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D015278:Intensive Care Units, Pediatric; D008297:Male; D010351:Patient Discharge; D011237:Predictive Value of Tests; D012121:Respiration, Artificial; D012189:Retrospective Studies; D014139:Tracheostomy
keywords: children; mechanical ventilation; pediatric intensive care unit (PICU); tracheostomy