(1765) Pediatric Severe Traumatic Brain Injury and Optimal Timing of Tracheostomy Placement

Introduction: There is limited research examining the ideal timing of tracheostomy placement in pediatric patients with severe traumatic brain injury (TBI). Current adult TBI data suggests tracheostomy before 7 days post injury leads to improved patient outcomes. The goal of this study is to determine number of days to tracheostomy among pediatric severe TBI patients at a single center pediatric intensive care unit (PICU) located at Memorial Health University Medical Center (MHUMC). Secondary aims include collecting descriptive data regarding patient demographics, clinical outcomes, and tracheostomy complications.

Methods: Retrospective chart review at a single center PICU, level 1 trauma center. Inclusion criteria: pediatric patients (age 0-17 years old) undergoing tracheostomy after severe TBI during 1/1/2016 - 9/1/2023. Exclusion criteria: patients requiring an emergent cricothyroidotomy, emergent tracheostomy, or conversion to tracheostomy following an emergent cricothyroidotomy.

Results: Thirteen pediatric severe TBI patients underwent tracheostomy. Mean days to tracheostomy post injury was 14 days ± 4 (range 9-26). Mean age 11 years ± 5 (range 2-17), 92% were male, and mean injury severity score (ISS) 31 ± 9. Blunt trauma was the majority mechanism of injury, 92%. Mean ICU days 31 ± 13 (range 18-65). Mean mechanical ventilator days 18 ± 5 (range 12-29). Ventilator associated pneumonia (VAP) occurred in 5/13 (39%), tracheitis 1/13 (8%), tracheal bleeding 1/13 (8%), and granuloma formation 1/13 (8%). Decannulation occurred in 12/13 (92%) patients. Patient disposition included inpatient rehabilitation 9/13 (69%), home 3/13 (23%), and death 1/13 (8%).

Conclusions: Pediatric severe TBI patients at MHUMC all underwent tracheostomy placement more than 7 days post injury. Results of mean ICU days, mechanical ventilation days, tracheostomy complications, and discharge disposition were similar with previous pediatric TBI studies. Despite MHUMC patients’ late tracheostomy placements, there was no association with increased mortality or inability to decannulate. Adult recommendations of early tracheostomy in severe TBI is challenging to achieve in pediatrics. More studies examining the ideal timing of tracheostomy in pediatric severe TBI patients are needed.