title: Early versus late tracheostomy in pediatric intensive care unit: does it matter? A 6-year experience.
abstract: BACKGROUND
  The aim of this study is to examine the clinical data of children who underwent tracheostomy during their stay in Pediatric Intensive Care Unit (PICU), in order to describe the relationship between the timing of tracheostomy, the length of PICU stay and the occurrence of ventilator-associated pneumonia (VAP).
  
  
  METHODS
  This is a retrospective cohort study that collects all patients undergoing tracheostomy during their PICU stay over a six-year period. Data collection included PICU length of stay, days of intubation, days of mechanical ventilation, primary indication for tracheostomy, information about VAP and decannulations. The early tracheostomy group was defined as patients who had ten or fewer days of continuous ventilation, whereas the late tracheostomy group had more than ten days of continuous ventilation.
  
  
  RESULTS
  A significant decrease in the rate of VAP incidence was noticed in the early tracheostomy group vs. late group (P=0.004, OR=0.39, 95% CI: 0.18-0.85). No differences were observed about decannulation, need of long-term ventilation and death rate. Significant decreases of days of mechanical ventilation and PICU stay were found in subgroup of patients who underwent early tracheostomy and were decannulated within 18 months.
  
  
  CONCLUSIONS
  No standard timing for tracheostomy placement has been established in the pediatric population. Early tracheostomy can shorten the days of ventilation and hospitalization in PICU and reduce the incidence of VAP, but further studies are needed to identify patient categories in which it can be of benefit.
authors.affiliation: Pediatric Intensive Care Unit, Department of Anesthesiology and Intensive Care, Sacro Cuore Catholic University, Rome, Italy.
authors.forename: Alessandro
authors.initials: A
authors.lastname: Pizza
authors.affiliation: Pediatric Intensive Care Unit, Department of Anesthesiology and Intensive Care, Sacro Cuore Catholic University, Rome, Italy - enzo.picconi@yahoo.it.
authors.forename: Enzo
authors.initials: E
authors.lastname: Picconi
authors.affiliation: Pediatric Intensive Care Unit, Department of Anesthesiology and Intensive Care, Sacro Cuore Catholic University, Rome, Italy.
authors.forename: Marco
authors.initials: M
authors.lastname: Piastra
authors.affiliation: Pediatric Intensive Care Unit, Department of Anesthesiology and Intensive Care, Sacro Cuore Catholic University, Rome, Italy.
authors.forename: Orazio
authors.initials: O
authors.lastname: Genovese
authors.affiliation: Pediatric Intensive Care Unit, Department of Anesthesiology and Intensive Care, Sacro Cuore Catholic University, Rome, Italy.
authors.forename: Daniele G
authors.initials: DG
authors.lastname: Biasucci
authors.affiliation: Pediatric Intensive Care Unit, Department of Anesthesiology and Intensive Care, Sacro Cuore Catholic University, Rome, Italy.
authors.forename: Giorgio
authors.initials: G
authors.lastname: Conti
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D005260:Female; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D015278:Intensive Care Units, Pediatric; D007902:Length of Stay / Q000706:statistics & numerical data*; D008297:Male; D053717:Pneumonia, Ventilator-Associated / Q000453:epidemiology / Q000517:prevention & control*; D012189:Retrospective Studies; D013997:Time Factors; D014139:Tracheostomy / Q000379:methods*