The Effect of Tracheostomy Timing on Clinical Outcomes in Children
Introduction:Optimal timing for tracheostomy in children is not well defined. Our aim is to examine the pre-tracheostomy morbidities, indications and association of early tracheostomy on clinical outcomes.Methods:This retrospective cohort study included all patients who underwent tracheostomy in the...
| Main Authors: | , , , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
Galenos Yayinevi
2023-08-01
|
| Series: | Journal of Pediatric Emergency and Intensive Care Medicine |
| Subjects: | |
| Online Access: |
http://www.caybdergi.com/archives/archive-detail/article-preview/the-effect-of-tracheostomy-timing-on-clinical-outc/60500
|
| _version_ | 1797813572104880128 |
|---|---|
| author | Tolga Besci Tuğçe Ak Göktuğ Özdemir Gültaç Evren Gazi Arslan Murat Duman |
| author_facet | Tolga Besci Tuğçe Ak Göktuğ Özdemir Gültaç Evren Gazi Arslan Murat Duman |
| author_sort | Tolga Besci |
| collection | DOAJ |
| description | Introduction:Optimal timing for tracheostomy in children is not well defined. Our aim is to examine the pre-tracheostomy morbidities, indications and association of early tracheostomy on clinical outcomes.Methods:This retrospective cohort study included all patients who underwent tracheostomy in the Dokuz Eylül University Pediatric Intensive Care Unit (ICU) between January 2012 and September 2020. We categorized patients into the early and late tracheostomy groups according to time on a mechanical ventilator before tracheostomy using a cut-off of 14 days. Pre-tracheostomy morbidities [ventilator associated pneumonia (VAP), central line associated bloodstream infection], indications and clinical outcomes (including length of ICU and hospital stay, incidence of VAP and mortality) were compared between early and late groups.Results:Of the 104 patients undergone tracheostomy, 90 were included in the study: Thirty patients in the early group, 60 patients in the late group. Tracheostomy rate of our unit was 6.06%, with a median ventilator time before tracheostomy of 20 days. VAP and lung tissue disease indication for tracheostomy independently increased pre-tracheostomy mechanical ventilation time by 8 and 12.6 days, respectively. There was no statistically significant difference in VAP rate after tracheostomy, successful decannulation and mortality between early and late group. Early group had lower post-tracheostomy ICU-length of stay (LOS) (8.5 vs. 13 days p=0.041) and total ICU-LOS (17.5 vs. 45 days p<0.001). Controlling for age, tracheostomy indication, central line associated bloodstream infection and VAP; tracheostomy timing was independently associated with ICU-LOS. Late tracheostomy timing increased the ICU-LOS by 10.7 days (p=0.041).Conclusion:Our results suggest that early timing of tracheostomy is associated with reduced ICU-LOS and VAP in children, consistent with the current literature. |
| first_indexed | 2024-03-13T07:53:44Z |
| format | Article |
| id | doaj.art-12bee5cd73174d1ba38422e56c0cb303 |
| institution | Directory Open Access Journal |
| issn | 2146-2399 2148-7332 |
| language | English |
| last_indexed | 2024-03-13T07:53:44Z |
| publishDate | 2023-08-01 |
| publisher | Galenos Yayinevi |
| record_format | Article |
| series | Journal of Pediatric Emergency and Intensive Care Medicine |
| spelling | doaj.art-12bee5cd73174d1ba38422e56c0cb3032023-06-02T06:58:30ZengGalenos YayineviJournal of Pediatric Emergency and Intensive Care Medicine2146-23992148-73322023-08-0110211111610.4274/cayd.galenos.2022.9483413049054The Effect of Tracheostomy Timing on Clinical Outcomes in ChildrenTolga Besci0Tuğçe Ak1Göktuğ Özdemir2Gültaç Evren3Gazi Arslan4Murat Duman5 Dokuz Eylül University Faculty of Medicine, Department of Pediatric Intensive Care Unit, İzmir, Turkey Dokuz Eylül University Faculty of Medicine, Department of Pediatrics, İzmir, Turkey Dokuz Eylül University Faculty of Medicine, Department of Pediatric Intensive Care Unit, İzmir, Turkey Dokuz Eylül University Faculty of Medicine, Department of Pediatric Intensive Care Unit, İzmir, Turkey Dokuz Eylül University Faculty of Medicine, Department of Pediatric Intensive Care Unit, İzmir, Turkey Dokuz Eylül University Faculty of Medicine, Department of Pediatric Emergency, İzmir, Turkey Introduction:Optimal timing for tracheostomy in children is not well defined. Our aim is to examine the pre-tracheostomy morbidities, indications and association of early tracheostomy on clinical outcomes.Methods:This retrospective cohort study included all patients who underwent tracheostomy in the Dokuz Eylül University Pediatric Intensive Care Unit (ICU) between January 2012 and September 2020. We categorized patients into the early and late tracheostomy groups according to time on a mechanical ventilator before tracheostomy using a cut-off of 14 days. Pre-tracheostomy morbidities [ventilator associated pneumonia (VAP), central line associated bloodstream infection], indications and clinical outcomes (including length of ICU and hospital stay, incidence of VAP and mortality) were compared between early and late groups.Results:Of the 104 patients undergone tracheostomy, 90 were included in the study: Thirty patients in the early group, 60 patients in the late group. Tracheostomy rate of our unit was 6.06%, with a median ventilator time before tracheostomy of 20 days. VAP and lung tissue disease indication for tracheostomy independently increased pre-tracheostomy mechanical ventilation time by 8 and 12.6 days, respectively. There was no statistically significant difference in VAP rate after tracheostomy, successful decannulation and mortality between early and late group. Early group had lower post-tracheostomy ICU-length of stay (LOS) (8.5 vs. 13 days p=0.041) and total ICU-LOS (17.5 vs. 45 days p<0.001). Controlling for age, tracheostomy indication, central line associated bloodstream infection and VAP; tracheostomy timing was independently associated with ICU-LOS. Late tracheostomy timing increased the ICU-LOS by 10.7 days (p=0.041).Conclusion:Our results suggest that early timing of tracheostomy is associated with reduced ICU-LOS and VAP in children, consistent with the current literature. http://www.caybdergi.com/archives/archive-detail/article-preview/the-effect-of-tracheostomy-timing-on-clinical-outc/60500 tracheostomypediatric intensive care unitventilator associated pneumonia |
| spellingShingle | Tolga Besci Tuğçe Ak Göktuğ Özdemir Gültaç Evren Gazi Arslan Murat Duman The Effect of Tracheostomy Timing on Clinical Outcomes in Children Journal of Pediatric Emergency and Intensive Care Medicine tracheostomy pediatric intensive care unit ventilator associated pneumonia |
| title | The Effect of Tracheostomy Timing on Clinical Outcomes in Children |
| title_full | The Effect of Tracheostomy Timing on Clinical Outcomes in Children |
| title_fullStr | The Effect of Tracheostomy Timing on Clinical Outcomes in Children |
| title_full_unstemmed | The Effect of Tracheostomy Timing on Clinical Outcomes in Children |
| title_short | The Effect of Tracheostomy Timing on Clinical Outcomes in Children |
| title_sort | effect of tracheostomy timing on clinical outcomes in children |
| topic | tracheostomy pediatric intensive care unit ventilator associated pneumonia |
| url |
http://www.caybdergi.com/archives/archive-detail/article-preview/the-effect-of-tracheostomy-timing-on-clinical-outc/60500
|
| work_keys_str_mv | AT tolgabesci theeffectoftracheostomytimingonclinicaloutcomesinchildren AT tugceak theeffectoftracheostomytimingonclinicaloutcomesinchildren AT goktugozdemir theeffectoftracheostomytimingonclinicaloutcomesinchildren AT gultacevren theeffectoftracheostomytimingonclinicaloutcomesinchildren AT gaziarslan theeffectoftracheostomytimingonclinicaloutcomesinchildren AT muratduman theeffectoftracheostomytimingonclinicaloutcomesinchildren AT tolgabesci effectoftracheostomytimingonclinicaloutcomesinchildren AT tugceak effectoftracheostomytimingonclinicaloutcomesinchildren AT goktugozdemir effectoftracheostomytimingonclinicaloutcomesinchildren AT gultacevren effectoftracheostomytimingonclinicaloutcomesinchildren AT gaziarslan effectoftracheostomytimingonclinicaloutcomesinchildren AT muratduman effectoftracheostomytimingonclinicaloutcomesinchildren |