OSF Children's Hospital of Illinois, Peoria, IL, USA.
Department of Surgery, Levine Children's Hospital, Charlotte, NC, USA.
Int J Artif Organs. 2020 Nov;43(11):726-734. doi: 10.1177/0391398820913571. Epub 2020 Mar 31.
Pediatric extracorporeal membrane oxygenation typically necessitates protracted ventilator support, yet not much is known about the use of tracheostomy in the pediatric subpopulation. The study was designed with an objective to quantify the prevalence of tracheostomy in children with respiratory/cardiac failure requiring extracorporeal membrane oxygenation and to compare outcomes for patients undergoing early, late, and no tracheostomy.
Data of patients <18 years of age who underwent extracorporeal membrane oxygenation for respiratory/cardiac failure between 2009 and 2015 were obtained from the Virtual Pediatric Systems (VPS, LLC) Database. Patients who underwent post-operative cardiac ECMO were excluded. Early versus late tracheostomy was defined as ⩽21 or >21 days after intensive care unit admission.
Data were analyzed for 2127 patients meeting inclusion and exclusion criteria. Five percent (107/2127) underwent a tracheostomy. Of these, 28% (30/107) underwent early and 72% (77/107) late tracheostomy. A higher mortality was found in the no tracheostomy group (41.3%) compared to early (13.3%) and late tracheostomy (14.3%) groups. Late tracheostomy was associated with 2.4 times the expected intensive care unit length of stay and 1.87 times the expected ventilator days as compared to patients with no tracheostomy. Early tracheostomy was associated with a shorter intensive care unit length of stay (p value < 0.001) and ventilator days (p value = 0.04) compared to late tracheostomy and no difference with the no tracheostomy group.
Late tracheostomy (>21 days) is associated with worse outcomes in the cohort of children who underwent Pediatric extracorporeal membrane oxygenation compared to patients who did not undergo tracheostomy. Early tracheostomy is associated with shorter intensive care unit stay and ventilator duration when compared to late tracheostomy.
儿科体外膜肺氧合（ECMO）通常需要长时间的呼吸机支持，但对于儿科人群中气管切开术的应用知之甚少。本研究旨在量化需要体外膜肺氧合的呼吸/心脏衰竭儿童中气管切开术的发生率，并比较早期、晚期和无气管切开术患者的结局。
从虚拟儿科系统（VPS，LLC）数据库中获取 2009 年至 2015 年期间因呼吸/心脏衰竭接受 ECMO 的<18 岁患者的数据。排除术后接受心脏 ECMO 的患者。早期与晚期气管切开术的定义为入住重症监护病房后<21 或>21 天。
对符合纳入和排除标准的 2127 例患者进行了数据分析。5%（107/2127）接受了气管切开术。其中，28%（30/107）为早期气管切开术，72%（77/107）为晚期气管切开术。无气管切开组（41.3%）的死亡率高于早期（13.3%）和晚期（14.3%）气管切开组。与无气管切开组相比，晚期气管切开术与预计重症监护病房住院时间延长 2.4 倍和预计呼吸机天数延长 1.87 倍相关。与晚期气管切开术相比，早期气管切开术与较短的重症监护病房住院时间（p 值<0.001）和呼吸机使用时间（p 值=0.04）相关，与无气管切开术组无差异。
与未行气管切开术的患儿相比，接受儿科 ECMO 的患儿中晚期（>21 天）气管切开术与较差的结局相关。与晚期气管切开术相比，早期气管切开术与较短的重症监护病房住院时间和呼吸机使用时间相关。
