This is a preprint, a preliminary version of a manuscript that has not completed peer review at a journal. Research Square does not conduct peer review prior to posting preprints. The posting of a preprint on this server should not be interpreted as an endorsement of its validity or suitability for dissemination as established information or for guiding clinical practice.
Research
Tadashi Ishihara
Juntendo University Urayasu Hospital
Corresponding Author
ORCiD: https://orcid.org/0000-0002-1418-2349
License:
This work is licensed under a CC BY 4.0 License. Read Full License
Background
The most common current indications of pediatric tracheostomy include prolonged ventilator dependence, often resulting from the consequences of prematurity and bronchopulmonary dysfunction, and upper airway obstruction resulting either from craniofacial or structural abnormalities of the upper airway or from hypotonia stemming from neurological or neuromuscular disturbance. The purpose of this study was to describe the indications, epidemiology, frequency, and associated factors for tracheostomy in critical pediatric patients admitted to the intensive care unit (ICU) or pediatric intensive care unit (PICU) by using the large amount of data available in the Japanese Registry of Pediatric Acute Care (JaRPAC).
Methods
In this retrospective multicenter cohort study, we collected data concerning pediatric tracheostomy from the JaRPAC database involving patients aged ≤ 16 years who had no tracheostomy when admitted to ICU or PICU between April 2014 and March 2017. The patients were divided into two groups: those with tracheostomies when they were discharged from the ICU or PICU and patients without tracheostomies. Interrelated factors of tracheostomy were investigated.
Results
A total of 23 hospitals participated, involving 6,199 pediatric patients registered in the JaRPAC database during the study period. Of the registered pediatric patients, 5,769 (95%) patients were admitted to the ICU or PICU without tracheostomies. Among the patients, 181 patients (3.1%) had undergone tracheostomies. There were significant differences in the number of chronic conditions (134, 74.0% versus 3096, 55.4%, p < 0.01), chromosomal anomalies (19, 10.5% versus 326, 5.8%, p < 0.01), urgent admission (151, 83.4% versus 3093, 55.4%, p < 0.01). More tracheostomies were performed on patients who were admitted for respiratory failure (61, 33.7% versus 926, 16.1%, p < 0.01) and for post-CPA resuscitation (40, 22.1% versus 71, 1.1%, p < 0.01).
Conclusions
This is the first report to use a large-scale registry of critically ill pediatric patients in Japan to describe the interrelated factors of tracheostomies during their stay in ICUs or PICUs. Chronic conditions (especially for neuromuscular disease), chromosomal anomaly, urgent admission, admission due to respiratory failure, or treatment for post-CPA resuscitation all had the possibility to be risk factors for tracheostomy.
Keywords
tracheostomy, Intensive care, Pediatric
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This is a preprint, a preliminary version of a manuscript that has not completed peer review at a journal. Research Square does not conduct peer review prior to posting preprints. The posting of a preprint on this server should not be interpreted as an endorsement of its validity or suitability for dissemination as established information or for guiding clinical practice.
Research
Tadashi Ishihara
Juntendo University Urayasu Hospital
Corresponding Author
ORCiD: https://orcid.org/0000-0002-1418-2349
Badges
Prescreen
This manuscript passed our Prescreen assessment
Complete author information
Appropriate declaration statements
Potential risks to human health
Prescreen
History
CURRENT STATUS: Posted
Version 1
Posted 14 Jan, 2020
No community comments so far
Metrics
Comments: 0
PDF Downloads: ...
HTML Views: ...
License:
This work is licensed under a CC BY 4.0 License. Read Full License
Background
The most common current indications of pediatric tracheostomy include prolonged ventilator dependence, often resulting from the consequences of prematurity and bronchopulmonary dysfunction, and upper airway obstruction resulting either from craniofacial or structural abnormalities of the upper airway or from hypotonia stemming from neurological or neuromuscular disturbance. The purpose of this study was to describe the indications, epidemiology, frequency, and associated factors for tracheostomy in critical pediatric patients admitted to the intensive care unit (ICU) or pediatric intensive care unit (PICU) by using the large amount of data available in the Japanese Registry of Pediatric Acute Care (JaRPAC).
Methods
In this retrospective multicenter cohort study, we collected data concerning pediatric tracheostomy from the JaRPAC database involving patients aged ≤ 16 years who had no tracheostomy when admitted to ICU or PICU between April 2014 and March 2017. The patients were divided into two groups: those with tracheostomies when they were discharged from the ICU or PICU and patients without tracheostomies. Interrelated factors of tracheostomy were investigated.
Results
A total of 23 hospitals participated, involving 6,199 pediatric patients registered in the JaRPAC database during the study period. Of the registered pediatric patients, 5,769 (95%) patients were admitted to the ICU or PICU without tracheostomies. Among the patients, 181 patients (3.1%) had undergone tracheostomies. There were significant differences in the number of chronic conditions (134, 74.0% versus 3096, 55.4%, p < 0.01), chromosomal anomalies (19, 10.5% versus 326, 5.8%, p < 0.01), urgent admission (151, 83.4% versus 3093, 55.4%, p < 0.01). More tracheostomies were performed on patients who were admitted for respiratory failure (61, 33.7% versus 926, 16.1%, p < 0.01) and for post-CPA resuscitation (40, 22.1% versus 71, 1.1%, p < 0.01).
Conclusions
This is the first report to use a large-scale registry of critically ill pediatric patients in Japan to describe the interrelated factors of tracheostomies during their stay in ICUs or PICUs. Chronic conditions (especially for neuromuscular disease), chromosomal anomaly, urgent admission, admission due to respiratory failure, or treatment for post-CPA resuscitation all had the possibility to be risk factors for tracheostomy.
Figure 1
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