What question did this study set out to answer?

This research investigates how timing of tracheostomy affects hospital outcomes and recovery in pediatric patients.

March 26, 2026Critical Care Medicine0 citations

1218: Impact of Tracheostomy Timing on in- And Post-Hospital Outcomes

RHRyan HesseniusUniversity of Pittsburgh KMKimberly McMahonDuPont (United States)KLKatie LabgoldOffice of Tribal Affairs and Strategic Alliances

Key Points

This research investigates how timing of tracheostomy affects hospital outcomes and recovery in pediatric patients.
Retrospective cohort study of patients ≤21 years who received tracheostomy.
Data collected from a single center (Nemours Children’s Hospital Delaware) between 2014-2024.
Patients excluded included those in NICU, with congenital heart disease, or emergent tracheostomy.
Early tracheostomy defined as <21 days of invasive mechanical ventilation; late as ≥21 days.
Outcomes measured included ICU length of stay, decannulation rates, and changes in functional status score.
Early tracheostomy group had a 75% shorter expected ICU length of stay post-tracheostomy than late group (adjusted incidence rate ratio = 0.25, p<0.001).
No significant difference in decannulation rates between early and late groups (adjusted odds ratio = 0.92, p=0.88).
No significant difference in average functional status score change between groups (adjusted β = 0.73, p=0.62).

Abstract

Introduction: Prior studies show early tracheostomy has beneficial effects on in-hospital outcomes for pediatric patients, but the impact of tracheostomy timing on longer-term outcomes remains unknown. We hypothesized that early tracheostomy will be associated with both improved in- and post-hospital outcomes. Methods: We performed a single center retrospective cohort study of patients ≤21 years-old who received a tracheostomy at Nemours Children’s Hospital Delaware from 2014 to 2024. Patients admitted to the NICU, had congenital heart disease, or emergent tracheostomy were excluded. Early tracheostomy was defined as < 21 days of preceding invasive mechanical ventilation (IMV) and late tracheostomy as ≥21 days of IMV. The main in-hospital outcome was ICU LOS after tracheostomy. Post-hospital outcomes were patients undergoing decannulation at any time and change in functional status score (FSS) from time of tracheostomy through 9 months post-tracheostomy. The association of tracheostomy timing (referent = late group) with each outcome, adjusting for tracheostomy indication, were estimated using negative binomial (ICU LOS), logistic (decannulation), and linear (FSS change) regressions. Results: Of 61 eligible patients, 37 (61%) received early and 24 (39%) received late tracheostomy. The median weight at time of tracheostomy was 20.7kg. Tracheostomy indications differed between early and late groups (p=0.02), including upper airway obstruction (30% vs 8%), neurologic process (49% vs 38%), and lung disease (22% vs 54%). The early tracheostomy group had an expected 75% shorter ICU LOS after tracheostomy than late tracheostomy (adjusted incidence rate ratio = 0.25, 95% confidence interval (CI): 0.14, 0.44, p=< 0.001).. There was no difference between the early and late tracheostomy groups in the odds of undergoing decannulation (adjusted odds ratio=0.92, 95% CI: 0.29, 2.9, p=0.88) and average difference in FSS change (adjusted β =0.73, 95% CI: -2.2, 3.7, p=0.62). Conclusions: Children who underwent early tracheostomy had a shorter expected ICU LOS after tracheostomy compared to those who underwent late tracheostomy, but post-hospital outcomes were not different between groups. Additional work is warranted to further investigate timing of tracheostomy and its association with post-hospital outcomes.

Ask AI

Helpful

Bookmark

View Full Paper