[Liberation of mechanical ventilation in tracheostomized pediatric patients during their stay in the intensive care unit]

Abstract

Introduction: Tracheostomy in pediatric intensive care has a prevalence between 5% and 10% of patients on mechanical ventilation.

Objective: The objective of this study was to determine the duration and outcome of the weaning process from mechanical ventilation (MV) and the behavior according to the reason for the tracheostomy.

Methodology: Data from 59 patients under 18 years of age who received MV and underwent tracheostomy between January 2018 and March 2023 at the Juan P. Garrahan National Pediatric Hospital, Argentina, were retrospectively examined. Demographic variables, reasons for admission to the unit, days on MV, tracheostomy characteristics, and the weaning process from MV were recorded.

Results: The main reasons for tracheostomy were airway disorders (50.8%) and prolonged MV (30.5%). Notable variability was observed in the duration and success of the weaning process among different groups of patients. Patients with airway disorders showed a faster weaning (median: 1.5 days) and higher success in this process, while those with prolonged MV and neurological disorders experienced longer processes (medians: 25.5 and 28 days, respectively) and more patients required partial or total mechanical ventilation at the end of this process. The presence of diaphragmatic dysfunction was more common in those who took longer to wean.

Conclusion: The weaning from MV is a complex process, and the reason for the tracheostomy influences its progression.