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Early tracheostomy improves outcomes in severely injured children and adolescents

2014; Elsevier BV; Volume: 49; Issue: 4 Linguagem: Inglês

10.1016/j.jpedsurg.2013.09.002

1531-5037

Courtenay M. Holscher, Camille L. Stewart, Erik D. Peltz, Clay Cothren Burlew, Steven L. Moulton, James B. Haenel, Denis D. Bensard,

Airway Management and Intubation Techniques

Background Early tracheostomy has been advocated for adult trauma patients to improve outcomes and resource utilization. We hypothesized that timing of tracheostomy for severely injured children would similarly impact outcomes. Methods Injured children undergoing tracheostomy over a 10-year period (2002–2012) were reviewed. Early tracheostomy was defined as post-injury day ≤7. Data were compared using Student's t test, Pearson chi-squared test and Fisher exact test. Statistical significance was set at p < 0.05 with 95% confidence intervals. Results During the 10-year study period, 91 patients underwent tracheostomy following injury. Twenty-nine (32%) patients were <12 years old; of these, 38% received early tracheostomy. Sixty-two (68%) patients were age 13 to 18; of these, 52% underwent early tracheostomy. Patients undergoing early tracheostomy had fewer ventilator days (p = 0.003), ICU days (p = 0.003), hospital days (p = 0.046), and tracheal complications (p = 0.03) compared to late tracheostomy. There was no difference in pneumonia (p = 0.48) between early and late tracheostomy. Conclusion Children undergoing early tracheostomy had improved outcomes compared to those who underwent late tracheostomy. Early tracheostomy should be considered for the severely injured child. Summary Early tracheostomy is advocated for adult trauma patients to improve patient comfort and resource utilization. In a review of 91 pediatric trauma patients undergoing tracheostomy, those undergoing tracheostomy on post-injury day ≤7 had fewer ventilator days, ICU days, hospital days, and tracheal complications compared to those undergoing tracheostomy after post-injury day 7.