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Predictors of need for mechanical ventilation at discharge after tracheostomy in the PICU
Author(s) -
McCrory Michael C.,
Lee K. Jane,
Scanlon Matthew C.,
Wakeham Martin K.
Publication year - 2016
Publication title -
pediatric pulmonology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.866
H-Index - 106
eISSN - 1099-0496
pISSN - 8755-6863
DOI - 10.1002/ppul.23195
Subject(s) - medicine , mechanical ventilation , pediatric intensive care unit , odds ratio , retrospective cohort study , pediatrics , odds , cohort , hospital discharge , ventilation (architecture) , logistic regression , anesthesia , surgery , mechanical engineering , engineering
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.