Table 3.
Admission and discharge characteristics of patients receiving tracheostomies or initiated on chronic ventilation
| Characteristic, % (95% CI) | Tracheostomy alone n=1,034 | Invasive ventilation n=717 | Noninvasive ventilation n=381 | Any technology n=2.132 |
|---|---|---|---|---|
| Unplanned admission | 68.7 (65.8–71.4) | 75.6 (72.3–78.6) | 75.9 (71.3–79.9) | 72.2 (70.3–74.1) |
| Peri-operative | 48.6 (45.6–51.7) | 25.5 (22.5–28.9) | 28.6 (24.3–33.4) | 37.3 (35.3–39.4) |
| Origin | ||||
| Emergency department | 28 (25.4–30.9) | 37.2 (33.8–40.8) | 41.2 (36.3–46.2) | 33.5 (31.5–35.5) |
| General ward | 18.7 (16.4–21.2) | 15.8 (13.3–18.6) | 18.1 (14.5–22.3) | 17.6 (16–19.2) |
| OR/PACU/procedure suite | 38 (35.1–41) | 18.4 (15.7–21.4) | 25.2 (21.1–29.8) | 29.2 (27.3–31.1) |
| Intermediate unit | 4.2 (3.2–5.7) | 7.3 (5.6–9.4) | 2.4 (1.2–4.5) | 4.9 (4–5.9) |
| Another ICU | 8.6 (7–10.4) | 16 (13.5–18.9) | 5.2 (3.4–8) | 10.5 (9.2–11.8) |
| Chronic/rehabilitation facility | 0.5 (0.2–1.2) | 2.1 (1.3–3.4) | 0.5 (0.1–2.1) | 1 (0.7–1.6) |
| Pulmonary rehabilitation facility | 0.1 (0–0.7) | 0.1 (0–1) | 0.3 (0–1.9) | 0.1 (0–0.4) |
| Home/outpatient | 1.6 (1–2.6) | 2.5 (1.6–4) | 6.3 (4.2–9.2) | 2.8 (2.2–3.6) |
| Other | 0.3 (0.1–0.9) | 0.6 (0.2–1.5) | 0.8 (0.3–2.4) | 0.5 (0.3–0.9) |
| Admitted from another hospital | 17.9 (15.7–20.4) | 23.3 (20.3–26.5) | 16.5 (13.1–20.6) | 19.4 (17.8–21.2) |
| PIM2 risk of mortality, %, mean (SD) | 6 (13.2) | 8.4 (15) | 5 (8.2) | 6.6 (13.2) |
| Admitted to PICU with | ||||
| ICU beds | ||||
| ≤17 | 17.9 (15.7–20.4) | 21.8 (18.9–24.9) | 17.8 (14.3–22) | 19.2 (17.5–20.9) |
| 18–24 | 46.8 (43.8–49.9) | 47.1 (43.5–50.8) | 59.3 (54.3–64.2) | 49.2 (47.1–51.4) |
| ≥25 | 35.3 (32.4–38.3) | 31.1 (27.8–34.6) | 22.8 (18.9–27.3) | 31.6 (29.7–33.6) |
| Affiliated fellowship program | 66.2 (63.2–69) | 61.6 (58–65.1) | 68.2 (63.4–72.7) | 65 (62.9–67) |
| Disposition | ||||
| General ward | 51 (47.9–54) | 24.3 (21.3–27.5) | 24.5 (21.3–30.1) | 37.4 (35.4–39.5) |
| Intermediate unit | 19.5 (16.7–22.8) | 17 (14.4–20) | 6.6 (4.5–9.5) | 16.4 (14.7–18.5) |
| OR | 0.2 (0–0.8) | 0.6 (0.2–1.5) | – | 0.3 (0.1–0.6) |
| Another ICU | 5 (3.4–7.3) | 5.6 (3.6–8.6) | 4.4 (2.4–7.6) | 5.2 (3.9–6.7) |
| Home | 9.4 (7.7–11.3) | 30.1 (26.9–33.6) | 45.9 (40.9–50.8) | 24.7 (22.9–26.6) |
| Chronic/rehabilitation facility | 7.4 (5.9–9.1) | 17.4 (14.8–20.4) | 12.9 (10.6–15.2) | 9.9 (8.7–11.3) |
| Pulmonary rehabilitation | 0.9 (0.5–1.7) | 3.1 (2–4.6) | 3.4 (2–5.8) | 2.1 (1.5–2.8) |
| Hospice | – | 0.8 (0.4–1.9) | 0.8 (0.3–2.4) | 0.4 (0.2–0.8) |
| Morgue | 6.2 (4.9–7.8) | – | – | – |
| Other | 0.6 (0.3–1.3) | 0.3 (0.1–1.1) | 0.5 (0.1–2.1) | 0.5 (0.3–0.9) |
| Discharged to another hospital | 3 (2.1–4.2) | 3.3 (2.3–4.9) | 1 (0.4–2.8) | 2.8 (2.2–3.6) |
| Discharge POPCa | ||||
| No disability | 3 (1.7–5.4) | 0.7 (0.2–2.8) | 3.2 (1.4–6.9) | 2.2 (1.4–3.4) |
| Mild disability | 16.7 (13.2–20.7) | 8.2 (5.5–12.1) | 7.4 (4.4–12.1) | 11.4 (9.4–13.7) |
| Moderate disability | 42.9 (37.9–48) | 37.3 (31.8–43.1) | 35.8 (29.2–42.9) | 38.2 (35–41.5) |
| Severe disability | 32.8 (28.1–.37.8) | 50.6 (44.5–56.4) | 53.7 (46.5–60.7) | 42 (38.8–45.4) |
| Coma/vegetative state | 4.6 (2.9–7.4) | 3.2 (1.6–5.9) | – | 2.9 (2–4.3) |
| Discharge PCPCa | ||||
| No disability | 25.4 (21.2–30.1) | 21.1 (16.7–26.4) | 28.4 (22.4–35.3) | 23.9 (21.2–26.9) |
| Mild disability | 17.2 (13.7–21.5) | 23.7 (19–29) | 20 (14.9–26.4) | 19.4 (16.9–22.2) |
| Moderate disability | 24.6 (20.4–29.3) | 24.4 (19.7–29.8) | 13.2 (9–18.8) | 21.3 (18.6–24.1) |
| Severe disability | 28.1 (23.8–33) | 27.6 (22.6–33.1) | 38.4 (31.7–45.6) | 29.3 (26.3–32.4) |
| Coma/vegetative state | 4.6 (2.9–7.4) | 3.2 (1.6–5.9) | – | 2.9 (2–4.3) |
| Discharged on CPAPb | – | 6.1 (4.6–8.2) | 15.7 (12.4–19.8) | – |
| Length of PICU stay, median days (IQR) | 18 (8–31) | 33 (16–57) | 20 (15–32) | 25 (14–46) |
CI, confidence interval; CPAP, continuous positive airway pressure; PACU, post-anesthesia care unit; ICU, intensive care unit; IQR, interquartile range; LOS, length of stay; MV, mechanical ventilation; OR, operating room; PIM, Paediatric Index of Mortality; PCPC, Pediatric Cerebral Performance Categories; POPC, Pediatric Overall Performance Categories; PPV, positive pressure ventilation; SD, standard deviation
Pediatric Performance Categories available for 863 (40%) patients from 28 (38%), but reported for 837 patients because of 26 tracheostomy alone patients that died prior to discharge.
As opposed to conventional mechanical ventilation for patients on chronic IV or BiPAP for patients on chronic NIV.