Frequency and indications of elective tracheostomies in patients admitted at PICU.

Abstract

Objective: To determine the frequency and indications of elective tracheostomies in patients admitted at pediatric intensive care unit (PICU) in a tertiary care hospital. Study Design: Cross-sectional study. Setting: The PICU of National Institute of Child Health, Karachi, Pakistan. Period: May 2024 to November 2024. Methods: A total of 62 children of any gender, aged 1 month to 14 years, and admitted to PICU were analyzed. Pre-designed study proforma was used to record study variables such as age, gender, PRISM-III score, admission type, disease categorization at admission. All patients admitting in PICU were closely monitored, and admitting consultant, on-board pediatric surgeon, intensivist and otorhinolaryngologist assessed the need to perform tracheostomy. Data were analyzed using IBM-SPSS Statistics, version 26.0. Results: In a total of 62 children, 35 (56.5%) were boys. The mean age of the children was 6.53±4.2 years. The mean PRISM-III score was 10.40±3.79. The most common disease categorization were neuromuscular diseases, and respiratory diseases, documented in 22 (35.5%), and 16 (25.8%) children, respectively. There were 11 (17.7%) children who underwent tracheostomy. Among 11 children undergoing tracheostomy, neurological impairments, upper airway obstruction, and cardiopulmonary indications were noted among 4 (36.4%), 4 (36.4%), and 3 (27.3%) children, respectively. The severity of illness, as per PRISM-III score, was significantly higher in children who underwent tracheostomy (p=0.023). Conclusion: The frequency of tracheostomy was 17.7% in children admitted in PICU. Patients requiring tracheostomy demonstrated significantly higher PRISM-III scores. Neurological impairments, upper airway obstruction, and cardiopulmonary complications were most common indications behind tracheostomy.