Risk factors and outcomes of tracheostomy after prolonged mechanical ventilation in pediatric patients with heart disease

The indications for tracheostomy after prolonged mechanical ventilation among pediatric patients with heart disease are multifactorial and difficult to determine; therefore, knowing the risk factors and outcomes of tracheostomy may be useful for selecting patients who require tracheostomy. The aim of this study was to identify the risk factors and outcomes of tracheostomy after prolonged mechanical ventilation in pediatric patients with heart disease. We performed a retrospective, single-center observational study in consecutive patients with heart disease aged ≤18 years admitted to a pediatric intensive care unit at a tertiary children's hospital between January 2010 and December 2016. Patients who required prolonged mechanical ventilation (≥14 days) were included. Clinical characteristics and outcomes were compared between the patients with and without tracheostomy and the risk factors for receiving tracheostomy were assessed. Of the 85 patients who required prolonged mechanical ventilation, 20 (24%) underwent tracheostomy. The duration of mechanical ventilation before tracheostomy was 51 days, and pediatric intensive care unit lengths of stay in patients with and without tracheostomy were 83 and 34 days, respectively (P < 0.001). Risk factors for tracheostomy were multiple (≥2) surgeries and mean airway pressure ≥ 10 cmH2O after 14 days of mechanical ventilation. In patients with tracheostomy, six (30%) were successfully weaned from mechanical ventilation and two (10%) were de-cannulated. Tracheostomy complications included granulation tissue in three cases and airway obstruction in one. There was no difference in the survival rates of patients with and without tracheostomy (70% vs. 74%; P = 0.73). Although the mortality rate of patients with and those without tracheostomy were not significantly different, the baseline illness severity might be different. Further studies that adjust for patient factors, such as disease severity, are needed to determine the effect of tracheostomy on patient outcomes; however, this was beyond the scope of our study.