S62 Changing landscape of paediatric tracheostomy ventilation: single centre experience

Introduction and objectivesChildren on long term tracheostomy ventilation (tr-LTV) have complex needs and are high users of PICU, specialist inpatient beds, and community care packages. Improvements in survival in PICU, and changing expectations mean children with previously life limiting conditions are often offered tr-LTV. Although a Canadian study showed no increase in total numbers of tr-LTV patients,1 data on complexity and outcomes of tr-LTV children is sparse. We hypothesised that both numbers of patients, and complexity, were increasing. Our goal was to examine outcomes to inform counselling of families when tr-LTV was being considered.MethodsAll children established on home tr-LTV since 1998 at a large Children’s Hospital were included. Year/age of initiation, diagnostic group, treatment intention (‘bridge to recovery’ or ‘destination’2), and outcomes were recorded. Data were compared between 2 decades (1998–2008, 2009–19).Results56 patients were established on tr-LTV (table 1). Between the two decades 4.5 times (10 vs 46) more children were established on tr-LTV. Both the proportion established under 1yr of age (40% to 59%), or with multi-system problems (10% to 52%) increased.Whilst mortality was similar (20% vs 22%) in both groups, of the total 12 deaths, 9 patients had multi-system problems. Median time on tr-LTV for patients who died was 12 months (12,48 months). In total 9 patients weaned off ventilation of which 8 had single system involvement only.ConclusionsNot only has there been an increase in the number of patients receiving tr-LTV, but the patients are younger and have multi-system problems. This may impact on mortality.ReferencesMcDougall CM :ADC: 2013, 98(9):660–5Ray S: ADC: 2018,103(11):1080–1084.Abstract S62 Table 1 1998–2008 2009–2019 n 10 46 Sex (M:F) 5:5 20:26 Age of T-LTV initiation n(%) 1 yr 4 (40)6 (60) 27(59)19(41) Primary diagnosis n(%)NeuromuscularCNSRespiratory 6 (60)4 (40)0 10(22)16(35)20 (43) Multisystem n(%) 1 (10) 24(52) 24 hr ventilation n (%) 6 (60) 24(52) Outcome n(%) LiberatedTransitionedDeathCurrent patientInpatient-awaiting 1st discharge 1 (10)5(50)2(20)2(20)0 8(17)5(11)10(22)19(41)4(8) Destination patients n(%) 9(90) 28(61) Bridge patients n(%) 1(10) 18(39)