Tracheostomy in Mechanically Ventilated Children

The decision to perform a tracheostomy in a ventilated, intensive care unit (ICU) patient is a difficult one regardless of the patient’s age, but it is especially trying in children. There is little in the literature describing the indications for tracheostomy in pediatric patients, and its use in ventilated children is significantly less than in ventilated adults. In a retrospective, cohort study by Wakeham et al, the authors sought to describe the current tracheostomy practices in children, specifically examining frequency, timing and other clinical/demographic factors. Ultimately, the authors examined data on more than 13,000 mechanically ventilated pediatric intensive care unit (PICU) patients from a multisite PICU database and noted that 872 patients (6.6%) had tracheostomy tubes placed.

The investigators found that demographic and clinical characteristics are associated with the frequency and timing of tracheostomy among PICU patients requiring prolonged mechanical ventilation. They also found that frequency and timing varied significantly among PICUs independent of these characteristics. While this is the first multicenter study describing tracheostomy practices in the United States, it may provide more questions than answers due to its retrospective nature. On what are PICU practitioners basing their tracheostomy decisions?  For example, are these decisions predicated solely on clinical characteristics, or are practitioners influenced by available resources or personal beliefs about the practice?  Also, why do PICUs have such differences in tracheostomy timing? These questions need to be addressed in other multicenter studies to provide guidance for PICU practitioners.

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