Impact of Tracheotomy and Its Timing on Outcomes in Pediatric Patients with Prolonged Mechanical Ventilation: A Multicenter Study in China.

Introduction: To assess the impact of tracheotomy and its timing on outcomes in pediatric patients with prolonged mechanical ventilation (PMV).

Methods: This is a multicenter retrospective study based on patients across eleven PICUs in China from 2017 to 2022. Inclusion criteria encompassed patients aged between 29 days and 18 years who necessitated prolonged mechanical ventilation more than 6 hours per day for at least 21 days. Patients were classified into tracheotomy and non-tracheotomy; procedures were further stratified as early (<14 days), intermediate (14-30 days), or late (>30 days) after ventilation onset. The primary outcome was 180-day survival. Secondary outcomes included successful weaning at discharge, incidence of ventilation-associated pneumonia (VAP), post-discharge destinations, and PICU length of stay.

Results: Among 719 eligible children, 150 (20.9%) patients who received tracheotomy showed a significantly higher 180-day survival rate (aOR 1.98, [95%CI 1.23-3.26], P=0.01). No significant differences were observed in successful weaning (aOR 0.79, [95%CI 0.53-1.18], P=0.26) or VAP (aOR 0.77, [95%CI 0.51-1.14], P=0.2). Subgroup analysis revealed that tracheotomy improved 180-day survival in those with the central nervous system diseases and upper airway obstruction. Early tracheotomy was associated with shorter PICU stays compared to intermediate/late groups (median 43 [IQR 34-58] vs. 57 [IQR 34-65] vs. 65 [IQR 56-108], P<0.01).

Conclusions: Tracheotomy might be associated with improved 180-day survival in pediatric PMV patients, yet its timing showed no clear association with primary outcomes in our analysis. Given potential residual confounding, larger multicenter studies in more diverse populations are needed to verify and extend these findings.