Predictors of need for mechanical ventilation at discharge after tracheostomy in the PICU. Issue 1 (30th March 2015) - McCrory, Michael C.
Summary: Background: The objective of this study was to determine factors predictive of need for mechanical ventilation (MV) upon discharge from the pediatric intensive care unit (PICU) among patients who receive a tracheostomy during their stay. Methods: This was a retrospective cohort study using the Virtual PICU Systems (VPS) database. Patients <18 years old admitted between 2009‐2011 who required MV for at least 3 days and received a tracheostomy during their PICU stay were included. Results: A total of 680 pediatric patients from 74 PICUs were included, of whom 347 (51%) remained on MV at the time of PICU discharge. Neonates (30/38, 79%) and infants (129/203, 64%) required MV at PICU discharge after tracheostomy more often than adolescents (66/141, 47%) and children (122/298, 41%). Time on MV pre‐tracheostomy was longer among those who required MV at discharge (median 18.3 vs. 13.8 days, P < 0.0001); however, number of failed extubations was similar (median 1 for both groups, P = 0.97). On mixed‐effects multivariable regression analysis, the age categories of neonate (OR 2.9, 95%CI 1.1–7.6, P = 0.03), and infant (OR 1.7, 95%CI 1.1–2.8, P = 0.03), and ventilator days prior to tracheostomy (OR 1.01, 95%CI 1.0–1.02, P = 0.01) were significantly associated with increased odds of MV upon PICU discharge, while being a trauma admission was associated with decreased odds (OR 0.45, 95%CI 0.28–0.73, P = 0.001). Conclusions: Younger patients and those with prolonged courses of MV prior to tracheostomy are more likely to continue to need MV upon PICU discharge.Pediatr Pulmonol. 2016;51:53–59. © 2015 Wiley Periodicals, Inc.