title: Children and Young Adults Who Received Tracheostomies or Were Initiated on Long-Term Ventilation in PICUs.
abstract: To characterize patients who received tracheostomies for airway compromise or were initiated on long-term ventilation for chronic respiratory failure in PICUs and to examine variation in the incidence of initiation, patient characteristics, and modalities across sites.
  
  
  
  Retrospective cross-sectional analysis.
  
  
  
  Seventy-three North American PICUs that participated in the Virtual Pediatric Systems, LLC.
  
  
  
  PICU patients admitted between 2009 and 2011.
  
  
  
  None.
  
  
  
  Among 115,437 PICU patients, 1.8% received a tracheostomy or were initiated on long-term ventilation; 1,034 received a tracheostomy only, 717 were initiated on invasive ventilation, and 381 were initiated on noninvasive ventilation. Ninety percent had substantial chronic conditions and comorbidities, including more than 50% with moderate or worse cerebral disability upon discharge. Seven percent were initiated after a catastrophic injury/event. Across sites, there was variation in incidence of tracheotomy and initiation of long-term ventilation, ranging from 0% to 4.6%. There also was variation in patient characteristics, time to tracheotomy, number of extubations prior to tracheostomy, and the use of invasive ventilation versus noninvasive ventilation.
  
  
  
  Although the PICU incidence of initiation of tracheostomies and long-term ventilation was relatively uncommon, it suggests that thousands of children and young adults receive these interventions each year in North American PICUs. The majority of them have conditions and comorbidities that impose on-going care needs, beyond those required by artificial airways and long-term ventilation themselves.
authors.affiliation: 1Division of Pediatric Critical Care, Department of Pediatrics, Columbia University College of Physician and Surgeons, New York, NY. 2Department of Physical Medicine and Rehabilitation, University of Pittsburgh, Pittsburgh, PA. 3Department of Statistics, University of California, Berkeley, CA. 4Division of Pulmonary, Allergy and Critical Care Medicine, Department of Pediatrics, Columbia University College of Physician and Surgeons, New York, NY. 5Division of Pediatric Allergy, Immunology and Rheumatology, Department of Pediatrics, Columbia University College of Physician and Surgeons, New York, NY. 6Division of Pediatric Pulmonology, Department of Pediatrics, Keck School of Medicine of University of Southern California, Los Angeles, CA. 7Division of Pulmonary Medicine, Department of Pediatrics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA. 8Division of Pulmonary and Critical Care, Department of Pediatrics, University of California, San Francisco, CA. 9Philip R. Lee Institute for Health Policy Studies, University of California, San Francisco, CA.
authors.forename: Jeffrey D
authors.initials: JD
authors.lastname: Edwards
authors.forename: Amy J
authors.initials: AJ
authors.lastname: Houtrow
authors.forename: Adam R
authors.initials: AR
authors.lastname: Lucas
authors.forename: Rachel L
authors.initials: RL
authors.lastname: Miller
authors.forename: Thomas G
authors.initials: TG
authors.lastname: Keens
authors.forename: Howard B
authors.initials: HB
authors.lastname: Panitch
authors.forename: R Adams
authors.initials: RA
authors.lastname: Dudley
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D002908:Chronic Disease; D003430:Cross-Sectional Studies; D005260:Female; D054625:Healthcare Disparities / Q000706:statistics & numerical data*; D006801:Humans; D007223:Infant; D015278:Intensive Care Units, Pediatric / Q000706:statistics & numerical data*; D008297:Male; D009656:North America; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D012121:Respiration, Artificial / Q000706:statistics & numerical data*; D012131:Respiratory Insufficiency / Q000175:diagnosis / Q000628:therapy*; D012189:Retrospective Studies; D014139:Tracheostomy / Q000706:statistics & numerical data*; D055815:Young Adult