(1577) Trials of Extubation in Pediatric Trauma Patients Undergoing Prolonged Mechanical Ventilation

Introduction: Tracheostomies occur in < 1% of pediatric intensive care unit (PICU) admissions. While tracheostomy placement after seven or fewer days of invasive mechanical ventilation is common in adult trauma patients, the same is not true for children. Among patients receiving mechanical ventilation for more than 7 days, we sought to 1) describe the timing of tracheostomy in trauma patients including the impact of tracheostomy on ICU and hospital length of stay, and 2) characterize and describe the trials of extubation for this population.

Methods: An existing Cincinnati Children’s trauma database was queried for patients mechanically ventilated >7 days from January 1, 2011 and December 31, 2021, with data stored in a secure electronic database per IRB requirements. Demographic, clinical, and outcome comparisons were made by Wilcoxon Rank Sum Test with Dunn’s post hoc comparison using rstatix in the R statistical package. Univariate and multivariate analysis was performed using final fit. P-values of < 0.05 were considered statistically significant.

Results: Among 52 patients ventilated for more than 7 days, 9 patients (17.3%) underwent tracheostomy, 9 (17.3%) died, with the remaining 34 (65.4%) extubated successfully. For extubated patients (n =34), 28 (82.3%) had one trial of extubation and 6 (17.6%) had two trials of extubation for a median ICU length of stay of 15 days. Median time between trials of extubation was 3.5 days and no patient needed a third trial. For patients who progressed to tracheostomy (n= 9), median time to tracheostomy was 21 days (range 0-33 days). 3 (33.3%) patients had one trial of extubation and 1 (11.1%) patient had two trials for a median length of stay of 27 days. For 5 (55.6%) patients who received no trial of extubation the median time to tracheostomy was 20 days.

Conclusions: In a preliminary sample of trauma patients intubated for >7 days, we saw no significant differences in ICU LOS or hospital LOS between patients undergoing tracheostomy and those successful extubated. There was also no significant difference in these values with a second trial of extubation. The next steps will include expansion of the study population to increase the power for detecting significant differences and to explore predictors for extubation failure and need for tracheostomy.