Pediatric tracheostomy: Survival and long-term outcomes

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Abstract

Objectives

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.

Introduction

The frequency and indications of pediatric tracheostomy have undergone notable changes over the last 30 years, and pediatric tracheostomy has recently become a relatively common procedure with approximately 5000 procedures performed in the United States each year [1]. Pediatric patients who require tracheostomy tend to be younger and with chronic diseases [1], [2], [3], [4], [5], [6], [7]. The current literature on pediatric tracheostomy contains limited objective data, especially those that describe Kaplan-Meier estimates of survival and long-term outcomes after pediatric tracheostomy.

The aim of this study was to investigate if there are any differences in survival and long-term outcomes between pediatric patients with and without neurological impairment who underwent tracheostomy. We hypothesized that the long-term outcomes would be worse in patients with neurological impairment regardless of their comorbidities. Thus, we categorized our pediatric patients into two groups using the pediatric cerebral performance category (PCPC) as those who were neurologically impaired (NI) (PCPC, 3–6) and those who were not neurologically impaired (NN) (PCPC, 1–2) at discharge from the pediatric intensive care unit (PICU). We evaluated survival and long-term outcomes by using the Kaplan-Meier method.

Section snippets

Materials and methods

This is a retrospective observational study at the PICU of the National Center for Child Health and Development (NCCHD) in Tokyo, Japan. This study was approved by the ethics committee of our institution (receipt number 1003).

Results

A total of 212 patients out of 10,250 patients in the PICU during the study period were included. Among the included patients, 141 were categorized into NI group (PCPC, 3–6) and 71 into NN group (PCPC, 1–2). The characteristics of the two groups are shown in Table 2. The age at tracheostomy was significantly older in NI group than in NN group (p < 0.001). In total patients, 142 patients were followed-up for more than one year, and 55 patients for more than five years. Deaths were reported in 47

Discussion

We reported the survival and long-term outcomes of patients after pediatric tracheostomy. Our findings were consistent with current reports and provide further information on long-term outcomes after pediatric tracheostomy [2], [3], [4], [5], [6], [7], [9], [10].

Funamura et al. demonstrated a difference in the overall decannulation rates among pediatric patients undergoing tracheostomy for different indications [2]. In the study, pediatric tracheostomy indications were categorized into five

Conclusions

By using the Kaplan-Meier method we demonstrated a lower decannulation rate in children with neurological impairment who underwent tracheostomy compared with that in children without neurological impairment who underwent tracheostomy. There were no significant differences in survival rates or the incidence of weaning from mechanical ventilation between the two groups. This information would be valuable to clinicians and families with children undergoing tracheostomy. Further investigations for

Conflict of interest statement

None.

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