Pediatric tracheostomy: Survival and long-term outcomes.
OBJECTIVE
The objective of this study was to investigate if there were any differences in survival and long-term outcomes between pediatric patients with and without neurological impairment who underwent tracheostomy.


METHODS
A retrospective chart review of pediatric patients (age 0-15 years) who underwent tracheostomy between March 2002 and December 2013 was conducted. Patients were categorized into two groups: those who were neurologically impaired (NI) (pediatric cerebral performance category, 3-6) and those who were not neurologically impaired (NN) (pediatric cerebral performance category, 1-2). Survival rates and cumulative incidence of weaning from mechanical ventilation or decannulation were calculated using the Kaplan-Meier method.


RESULTS
A total of 212 patients were included. Among them, 141 were categorized into NI group and 71 into NN group. Between the two groups, there were no significant differences in survival rates and cumulative incidence of weaning from mechanical ventilation. In total patients, one-year survival rate was 0.86 (95%CI 0.80-0.90) and five-year survival rate was 0.71 (0.62-0.78). One-year weaning rate was 0.58 (0.51-0.65) and five-year weaning rate was 0.66 (0.59-0.74). Decannulation rates were significantly lower in NI group than in NN group (p < 0.001). One-year and five-year decannulation rates were 0.04 (0.01-0.09) and 0.17 (0.10-0.29), respectively, in NI group, and 0.20 (0.12-0.33) and 0.54 (0.40-0.69), respectively, in NN group.


CONCLUSIONS
In children who underwent tracheostomy, the decannulation rate was lower in those with neurological impairment compared with that in those without neurological impairment. There were no significant differences in survival or ventilator weaning between the two groups.
Critical Care Medicine, National Center for Child Health and Development, Tokyo, Japan. Electronic address: tsuboi-n@ncchd.go.jp.
Norihiko
N
Tsuboi
Critical Care Medicine, National Center for Child Health and Development, Tokyo, Japan.
Kentaro
K
Ide
Critical Care Medicine, National Center for Child Health and Development, Tokyo, Japan.
Nao
N
Nishimura
Critical Care Medicine, National Center for Child Health and Development, Tokyo, Japan.
Satoshi
S
Nakagawa
Otorhinolaryngology, National Center for Child Health and Development, Tokyo, Japan.
Noriko
N
Morimoto
D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D015278:Intensive Care Units, Pediatric; D007564:Japan / Q000453:epidemiology; D008297:Male; D009422:Nervous System Diseases / Q000453:epidemiology*; D012189:Retrospective Studies; D015996:Survival Rate; D014139:Tracheostomy / Q000401:mortality*; D015300:Ventilator Weaning
Decannulation; Neurological impairment; Pediatric intensive care; Survival rate; Tracheostomy; Weaning