Division of Pediatric Critical Care Medicine, Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada.
Department of Pediatrics, University of Ottawa, Ottawa, ON, Canada.
Pediatr Crit Care Med. 2019 Sep;20(9):e423-e431. doi: 10.1097/PCC.0000000000002046.
To characterize the stated practices of qualified Canadian physicians toward tracheostomy for pediatric prolonged mechanical ventilation and whether subspecialty and comorbid conditions impact attitudes toward tracheostomy.
Cross sectional web-based survey.
Pediatric intensivists, neonatologists, respirologists, and otolaryngology-head and neck surgeons practicing at 16 tertiary academic Canadian pediatric hospitals.
Respondents answered a survey based on three cases (Case 1: neonate with bronchopulmonary dysplasia; Cases 2 and 3: children 1 and 10 years old with pediatric acute respiratory distress syndrome, respectively) including a series of alterations in relevant clinical variables.
We compared respondents' likelihood of recommending tracheostomy at 3 weeks of mechanical ventilation and evaluated the effects of various clinical changes on physician willingness to recommend tracheostomy and their impact on preferred timing (≤ 3 wk or > 3 wk of mechanical ventilation). Response rate was 165 of 396 (42%). Of those respondents who indicated they had the expertise, 47 of 121 (38.8%), 23 of 93 (24.7%), and 40 of 87 (46.0%) would recommend tracheostomy at less than or equal to 3 weeks of mechanical ventilation for cases 1, 2, and 3, respectively (p < 0.05 Case 2 vs 3). Upper airway obstruction was associated with increased willingness to recommend earlier tracheostomy. Life-limiting condition, severe neurologic injury, unrepaired congenital heart disease, multiple organ system failure, and noninvasive ventilation were associated with a decreased willingness to recommend tracheostomy.
This survey provides insight in to the stated practice patterns of Canadian physicians who care for children requiring prolonged mechanical ventilation. Physicians remain reluctant to recommend tracheostomy for children requiring prolonged mechanical ventilation due to lung disease alone at 3 weeks of mechanical ventilation. Prospective studies characterizing actual physician practice toward tracheostomy for pediatric prolonged mechanical ventilation and evaluating the impact of tracheostomy timing on clinically important outcomes are needed as the next step toward harmonizing care delivery for such patients.
描述加拿大合格医生对小儿长时间机械通气行气管切开术的实践情况，并探讨亚专科和合并症是否会影响气管切开术的态度。
横断面网络调查。
在 16 家加拿大三级学术儿科医院工作的儿科重症监护医师、新生儿科医师、呼吸科医师和耳鼻喉科-头颈外科医师。
调查对象根据 3 个病例（病例 1：患有支气管肺发育不良的新生儿；病例 2 和病例 3：分别为患有小儿急性呼吸窘迫综合征的 1 岁和 10 岁儿童）回答了一份调查，包括一系列相关临床变量的变化。
我们比较了调查对象在机械通气 3 周时推荐气管切开术的可能性，并评估了各种临床变化对医生愿意推荐气管切开术的影响及其对首选时机（机械通气≤3 周或＞3 周）的影响。应答率为 396 人中的 165 人（42%）。在表示有专业知识的应答者中，47 人（38.8%）、23 人（24.7%）和 40 人（46.0%）会分别推荐对病例 1、2 和 3在机械通气≤3 周时行气管切开术（病例 2 与病例 3 相比，p<0.05）。上气道梗阻与更愿意推荐早期气管切开术相关。生命有限的情况、严重的神经损伤、未修复的先天性心脏病、多器官系统衰竭和无创通气与降低推荐气管切开术的意愿相关。
本调查提供了加拿大医生治疗需要长时间机械通气的儿童的实践模式的见解。由于单独肺部疾病，医生在机械通气 3 周时仍不愿推荐对需要长时间机械通气的儿童行气管切开术。需要开展前瞻性研究，描述儿科长时间机械通气患者实际的医生气管切开术实践，并评估气管切开术时机对临床重要结局的影响，这是朝着协调此类患者的护理提供迈出的下一步。
