Evaluation of Short-term Outcomes of Tracheostomy Procedures in a NICU Population With High Ventilator Settings
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Date
2021-05
Authors
Journal Title
Journal ISSN
Volume Title
Publisher
The Ohio State University
Abstract
Objective: Investigation of whether tracheostomy placement in infants requiring high ventilator pressure is safe and effective.
Study Design: Case series with chart review
Setting: Tertiary children's hospital
Methods: Fifty ventilator-dependent neonatal intensive care unit patients who underwent tracheotomy from 2009 –2018 were included. Patients requiring high ventilator pressures were compared to those requiring low ventilator pressures. Demographics, comorbidities, surgical and clinical data were recorded.
Results: Thirty-two percent (n=16) had low ventilator settings at the time of tracheostomy tube placement, and 68% (n=34) had high ventilator settings. The median peak inspiratory pressure of the high ventilator group was 29.5 cm H2O, positive end-expiratory pressure (PEEP) was 8 cm H2O, mean airway pressure was 13 cm H2O, pressure support (PS) was 14 cm H2O, PS above PEEP was 6 cm H2O, and inspiratory time was 0.65 seconds. The high ventilator cohort had a higher median age at the time of surgery compared to the low ventilator group (p = 0.02). Female patients were more likely to have high ventilator settings (p = 0.02). There were no
intraoperative complications or deaths within the first 7 days of tracheostomy tube placement. Pneumonia incidence and rate of mortality during admission did not vary by ventilator settings (p = 0.92, p = 0.94, respectively).
Conclusion: Few differences in tracheostomy tube placement outcomes were observed for patients with high ventilator settings compared to low ventilator settings. This data demonstrates that patients requiring high ventilator pressures can benefit from tracheostomy tube placement with no additional short-term risks.
Description
Keywords
tracheostomy tube placement, tracheotomy, ventilator settings, otolaryngology, neonatology, pediatric
Citation
Published Citation: Banks L, Worobetz N, Hamersley E, Onwuka A, Shepherd E, Wiet G. Evaluation of Short-term Outcomes of Tracheostomy Procedures in a NICU Population With High Ventilator Settings. Otolaryngol Head Neck Surg. 2021 Mar 9:194599821996226. doi: 10.1177/0194599821996226. Epub ahead of print. PMID: 33687280.