Background Elective bedside pediatric tracheostomies in the intensive care unit
have not been widely reported. Unlike in the adult population, this is not
yet considered a safe or routine procedure in the pediatric population. We
performed a preliminary study suggesting that bedside pediatric tracheostomies
can be done safely and at reduced cost.
Design Retrospective medical chart review.
Setting Tertiary care referral center at a single university hospital.
Patients Fifty-seven patients, ranging in age from 15 days to 8 years. Thirty
operating room tracheostomies and 27 bedside tracheostomies were performed
during a 6-year period. The mean age of the patients was 20.5 months, with
no significant age difference between the 2 groups. The top 3 diagnoses necessitating
tracheostomy were laryngotracheal disorders (18 patients [32%]), bronchopulmonary
dysplasia (9 [16%]), and neurologic disorders (6 [11%]).
Interventions Tracheostomy.
Main Outcome Measures The initial 48-hour postoperative period was examined to compare complication
rates between groups.
Results Overall, the 2 groups had similar complication rates (
2
= 0.12; P = .73). The operating room group had 3
complications (10%) related to bleeding, infection, and pneumothorax. The
bedside group had 2 complications (7%), both involving pneumothorax. Each
operating room tracheostomy incurred charges totaling $1693 vs $235 for each
bedside tracheostomy.
Conclusions Historically, pediatric tracheostomy has been viewed as a technically
demanding procedure with a high complication rate, thus encouraging routine
operating room use. We found that pediatric tracheostomy performed in the
intensive care unit, with attention to prudent patient selection and adherence
to consistent, sound techniques, was as safe as operating room tracheostomy.
