Predictors of need for mechanical ventilation at discharge after tracheostomy in the PICU
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...
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| Veröffentlicht in: | Pediatric pulmonology 2016-01, Vol.51 (1), p.53-59 |
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| creator | McCrory, Michael C. Lee, K. Jane Scanlon, Matthew C. Wakeham, Martin K. |
| description | 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 |
| doi_str_mv | 10.1002/ppul.23195 |
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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.</description><identifier>ISSN: 8755-6863</identifier><identifier>EISSN: 1099-0496</identifier><identifier>DOI: 10.1002/ppul.23195</identifier><identifier>PMID: 25823590</identifier><language>eng</language><publisher>United States: Blackwell Publishing Ltd</publisher><subject>Adolescent ; Child ; Child, Preschool ; children ; Databases, Factual ; Female ; Hospitalization ; Humans ; Infant ; Infant, Newborn ; Intensive Care Units, Pediatric ; Male ; mechanical ventilation ; Patient Discharge ; pediatric intensive care unit (PICU) ; Predictive Value of Tests ; Respiration, Artificial ; Retrospective Studies ; Tracheostomy</subject><ispartof>Pediatric pulmonology, 2016-01, Vol.51 (1), p.53-59</ispartof><rights>2015 Wiley Periodicals, Inc.</rights><rights>2016 Wiley Periodicals, Inc.</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c3605-5674d6d1fbbc5859932d847fdabead6811018e31a4e1d2870c695ef029354d873</citedby></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://onlinelibrary.wiley.com/doi/pdf/10.1002%2Fppul.23195$$EPDF$$P50$$Gwiley$$H</linktopdf><linktohtml>$$Uhttps://onlinelibrary.wiley.com/doi/full/10.1002%2Fppul.23195$$EHTML$$P50$$Gwiley$$H</linktohtml><link.rule.ids>314,776,780,1411,27901,27902,45550,45551</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/25823590$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>McCrory, Michael C.</creatorcontrib><creatorcontrib>Lee, K. Jane</creatorcontrib><creatorcontrib>Scanlon, Matthew C.</creatorcontrib><creatorcontrib>Wakeham, Martin K.</creatorcontrib><title>Predictors of need for mechanical ventilation at discharge after tracheostomy in the PICU</title><title>Pediatric pulmonology</title><addtitle>Pediatr Pulmonol</addtitle><description>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.</description><subject>Adolescent</subject><subject>Child</subject><subject>Child, Preschool</subject><subject>children</subject><subject>Databases, Factual</subject><subject>Female</subject><subject>Hospitalization</subject><subject>Humans</subject><subject>Infant</subject><subject>Infant, Newborn</subject><subject>Intensive Care Units, Pediatric</subject><subject>Male</subject><subject>mechanical ventilation</subject><subject>Patient Discharge</subject><subject>pediatric intensive care unit (PICU)</subject><subject>Predictive Value of Tests</subject><subject>Respiration, Artificial</subject><subject>Retrospective Studies</subject><subject>Tracheostomy</subject><issn>8755-6863</issn><issn>1099-0496</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2016</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNpdkUtvEzEUhS0EoqGw4QcgS2zYTPFj_FpCBKUoKhEQIdhYzvgOcZkZB9sD5N_jNqULVvdK5ztXR_cg9JSSM0oIe7nfz8MZ49SIe2hBiTENaY28jxZaCdFILfkJepTzFSFVM_QhOmFCMy4MWaCv6wQ-dCWmjGOPJwCP-5jwCN3OTaFzA_4FUwmDKyFO2BXsQ65S-g7Y9QUSLsl1O4i5xPGAw4TLDvD6Yrl5jB70bsjw5Haeos3bN5-X75rVh_OL5atV03FJRCOkar30tN9uO6GFMZx53areuy04LzWlhGrg1LVAPdOKdNII6AkzXLReK36KXhzv7lP8OUMudqwJYRjcBHHOlipJtFKG6Yo-_w-9inOaarpKCSWMIG1bqWe31Lwdwdt9CqNLB_vvaRWgR-B3GOBwp1Nir-uw13XYmzrser1Z3WzV0xw9IRf4c-dx6YeViithv1ye2_evP4mP7Juxl_wv4hSLYA</recordid><startdate>201601</startdate><enddate>201601</enddate><creator>McCrory, Michael C.</creator><creator>Lee, K. Jane</creator><creator>Scanlon, Matthew C.</creator><creator>Wakeham, Martin K.</creator><general>Blackwell Publishing Ltd</general><general>Wiley Subscription Services, Inc</general><scope>BSCLL</scope><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>K9.</scope><scope>7X8</scope></search><sort><creationdate>201601</creationdate><title>Predictors of need for mechanical ventilation at discharge after tracheostomy in the PICU</title><author>McCrory, Michael C. ; Lee, K. Jane ; Scanlon, Matthew C. ; Wakeham, Martin K.</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c3605-5674d6d1fbbc5859932d847fdabead6811018e31a4e1d2870c695ef029354d873</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2016</creationdate><topic>Adolescent</topic><topic>Child</topic><topic>Child, Preschool</topic><topic>children</topic><topic>Databases, Factual</topic><topic>Female</topic><topic>Hospitalization</topic><topic>Humans</topic><topic>Infant</topic><topic>Infant, Newborn</topic><topic>Intensive Care Units, Pediatric</topic><topic>Male</topic><topic>mechanical ventilation</topic><topic>Patient Discharge</topic><topic>pediatric intensive care unit (PICU)</topic><topic>Predictive Value of Tests</topic><topic>Respiration, Artificial</topic><topic>Retrospective Studies</topic><topic>Tracheostomy</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>McCrory, Michael C.</creatorcontrib><creatorcontrib>Lee, K. Jane</creatorcontrib><creatorcontrib>Scanlon, Matthew C.</creatorcontrib><creatorcontrib>Wakeham, Martin K.</creatorcontrib><collection>Istex</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>MEDLINE - Academic</collection><jtitle>Pediatric pulmonology</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>McCrory, Michael C.</au><au>Lee, K. Jane</au><au>Scanlon, Matthew C.</au><au>Wakeham, Martin K.</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Predictors of need for mechanical ventilation at discharge after tracheostomy in the PICU</atitle><jtitle>Pediatric pulmonology</jtitle><addtitle>Pediatr Pulmonol</addtitle><date>2016-01</date><risdate>2016</risdate><volume>51</volume><issue>1</issue><spage>53</spage><epage>59</epage><pages>53-59</pages><issn>8755-6863</issn><eissn>1099-0496</eissn><abstract>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.</abstract><cop>United States</cop><pub>Blackwell Publishing Ltd</pub><pmid>25823590</pmid><doi>10.1002/ppul.23195</doi><tpages>7</tpages></addata></record> |
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| subjects | Adolescent Child Child, Preschool children Databases, Factual Female Hospitalization Humans Infant Infant, Newborn Intensive Care Units, Pediatric Male mechanical ventilation Patient Discharge pediatric intensive care unit (PICU) Predictive Value of Tests Respiration, Artificial Retrospective Studies Tracheostomy |
| title | Predictors of need for mechanical ventilation at discharge after tracheostomy in the PICU |
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