Tracheostomy Placement and Clinical Outcomes for Children Unable to Liberate From Mechanical Ventilation in the PICU

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In critically ill children, an increasing number of unsuccessful extubation attempts is associated with a higher likelihood of new tracheostomy tube placement, increased use of noninvasive respiratory support, longer time to reintubation, and increased mortality. Novelty: ClaimNovelty.INCREMENTAL. Consensus alignment: ConsensusAlignment.NEUTRAL.

Colin Rogerson; Jeremy Loberger; Samer Abu-Sultaneh

doi:10.1097/pcc.0000000000004034

September 7, 2026Pediatric Critical Care Medicine

Tracheostomy Placement and Clinical Outcomes for Children Unable to Liberate From Mechanical Ventilation in the PICU

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Key Points

To evaluate whether repeated extubation failures are associated with higher rates of new tracheostomy tube placement, increased noninvasive respiratory support, and delayed reintubation in pediatric intensive care.
Retrospective cohort study analyzing N=14,085 encounters (<19 years old) intubated for ≥24 hours who required reintubation within 7 days in the Virtual Pediatric Systems Database (2013–2022).
Assessed frequencies of new tracheostomy placement, reintubation counts, and pre-reintubation noninvasive respiratory support using mixed-effects logistic regression modeling.
New tracheostomy tubes were placed in 8.9% (1,255/14,085) of encounters, with each additional extubation attempt independently increasing placement odds (OR 1.42, 95% CI [1.32–1.52], p < 0.01).
Mortality increased linearly from 8.1% after one failed extubation attempt to 20.9% after five or more attempts, while noninvasive respiratory support use peaked at 59.2% on the second attempt.
Among patients undergoing two or more extubation attempts, tracheostomy placement was associated with longer mechanical ventilation duration and hospital stay, but significantly lower mortality.

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Implication

Retrospective cohort study reveals increased extubation attempts elevate tracheostomy rates and mortality in critically ill children, highlighting the risks of repeated liberation failures.

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Cite This Study

Rogerson et al. (2026) studied this question.

synapsesocial.com/papers/6a9fd7d558e84d0ff5b46e69 https://doi.org/10.1097/pcc.0000000000004034

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Tracheostomy Placement and Clinical Outcomes for Children Unable to Liberate From Mechanical Ventilation in the PICU

Key Points

No abstract yet

Implication

Discussion

Cite This Study

Tracheostomy Placement and Clinical Outcomes for Children Unable to Liberate From Mechanical Ventilation in the PICU

Key Points

No abstract yet

Implication

Discussion

Cite This Study

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