دورية أكاديمية
أعرض في EDS

Effect of tracheostomy timing in pediatric patients with traumatic brain injury.

التفاصيل البيبلوغرافية
العنوان: Effect of tracheostomy timing in pediatric patients with traumatic brain injury.
المؤلفون: Salik I; Department of Anesthesiology, Westchester Medical Center, Valhalla, NY, 10595, USA. Electronic address: Irim.Salik@wmchealth.org., Das A; New York Medical College School of Medicine, Valhalla, NY, 10595, USA., Naftchi AF; New York Medical College School of Medicine, Valhalla, NY, 10595, USA., Vazquez S; New York Medical College School of Medicine, Valhalla, NY, 10595, USA., Spirollari E; New York Medical College School of Medicine, Valhalla, NY, 10595, USA., Dominguez JF; Department of Neurosurgery, Westchester Medical Center, Valhalla, NY, 10595, USA., Sukul V; Department of Neurosurgery, Westchester Medical Center, Valhalla, NY, 10595, USA., Stewart D; Department of Surgery, Westchester Medical Center, Valhalla, NY, 10595, USA., Moscatello A; Department of Otolaryngology/Head and Neck Surgery, Westchester Medical Center, Valhalla, NY, 10595, USA.
المصدر: International journal of pediatric otorhinolaryngology [Int J Pediatr Otorhinolaryngol] 2023 Jan; Vol. 164, pp. 111414. Date of Electronic Publication: 2022 Dec 12.
نوع المنشور: Journal Article
اللغة: English
بيانات الدورية: Publisher: Elsevier Scientific Publishers Country of Publication: Ireland NLM ID: 8003603 Publication Model: Print-Electronic Cited Medium: Internet ISSN: 1872-8464 (Electronic) Linking ISSN: 01655876 NLM ISO Abbreviation: Int J Pediatr Otorhinolaryngol Subsets: MEDLINE
أسماء مطبوعة: Publication: Limerick : Elsevier Scientific Publishers
Original Publication: [Amsterdam] Elsevier/North-Holland.
مواضيع طبية MeSH: Tracheostomy*/adverse effects , Brain Injuries, Traumatic*/surgery, Adult ; Humans ; Child ; Adolescent ; Retrospective Studies ; Length of Stay ; Respiration, Artificial
مستخلص: Background: Traumatic brain injury (TBI) is a prevalent cause of disability and death in the pediatric population, often requiring prolonged mechanical ventilation. Patients with significant TBI or intracranial hemorrhage require advanced airway management to protect against aspiration, hypoxia, and hypercarbia, eventually necessitating tracheostomy. While tracheostomy is much less common in children compared to adults, its prevalence among pediatric populations has been steadily increasing. Although early tracheostomy has demonstrated improved outcomes in adult patients, optimal tracheostomy timing in the pediatric population with TBI remains to be definitively established.
Objective: This retrospective cohort analysis aims to evaluate pediatric TBI patients who undergo tracheostomy and to investigate the impact of tracheostomy timing on outcomes.
Design/methods: The Healthcare Cost and Utilization Project (HCUP) Kids' Inpatient Database (KID), collected between in 2016 and 2019, was queried using International Classification of Disease 10th edition (ICD10) codes for patients with traumatic brain injury who had received a tracheostomy. Baseline demographics, insurance status, and procedural day data were analyzed with univariate and multivariate regression analyses. Propensity score matching was performed to estimate the incidence of medical complications and mortality related to early versus late tracheostomy timing (as defined by median = 9 days).
Results: Of the 68,793 patients (mean age = 14, IQR 4-18) who suffered a TBI, 1,956 (2.8%) received a tracheostomy during their hospital stay. TBI patients who were tracheostomized were older (mean age = 16.5 vs 11.4 years), more likely to have injuries classified as severe TBIs and more likely to have accumulated more than one indicator of parenchymal injury as measured by the Composite Stroke Severity Scale (CSSS >1) than non-tracheostomized TBI patients. TBI patients with a tracheostomy were more likely to encounter serious complications such as sepsis, acute kidney injury (AKI), meningitis, or acute respiratory distress syndrome (ARDS). They were also more likely to necessitate an external ventricular drain (EVD) or decompressive hemicraniectomy (DHC) than TBI patients without a tracheostomy. Tracheostomy was also negatively associated with routine discharge. Procedural timing was assessed in 1,867 patients; older children (age >15 years) were more likely to undergo earlier placements (p < 0.001). Propensity score matching (PSM) comparing early versus late placement was completed by controlling for age, gender, and TBI severity. Those who were subjected to late tracheostomy (>9 days) were more likely to face complications such as AKI or deep vein thrombosis (DVT) as well as a host of respiratory conditions such as pulmonary embolism, aspiration pneumonitis, pneumonia, or ARDS. While the timing did not significantly impact mortality across the PSM cohorts, late tracheostomy was associated with increased length of stay (LOS) and ventilator dependence.
Conclusions: Tracheostomy, while necessary for some patients who have sustained a TBI, is itself associated with several risks that should be assessed in context of each individual patient's overall condition. Additionally, the timing of the intervention may significantly impact the trajectory of the patient's recovery. Early intervention may reduce the incidence of serious complications as well as length of stay and dependence on a ventilator and facilitate a timelier recovery.
Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.
(Copyright © 2022 Elsevier B.V. All rights reserved.)
فهرسة مساهمة: Keywords: Anesthesia; Intubation; Neurocritical care; Pediatric; Tracheostomy; Traumatic brain injury
تواريخ الأحداث: Date Created: 20221217 Date Completed: 20230109 Latest Revision: 20230111
رمز التحديث: 20231215
DOI: 10.1016/j.ijporl.2022.111414
PMID: 36527981
قاعدة البيانات: MEDLINE
الوصف
تدمد:1872-8464
DOI:10.1016/j.ijporl.2022.111414