Supplementary Material for: Impact of Tracheotomy and Its Timing on Outcomes in Pediatric Patients with Prolonged Mechanical Ventilation: A Multicenter Study in China

Introduction: To assess the impact of tracheotomy and its timing on outcomes in pediatric patients with prolonged mechanical ventilation (PMV).
Methods: This is a multicenter retrospective study based on patients across eleven PICUs in China from 2017 to 2022. Inclusion criteria encompassed patients aged between 29 days and 18 years who necessitated prolonged mechanical ventilation more than 6 hours per day for at least 21 days. Patients were classified into tracheotomy and non-tracheotomy; procedures were further stratified as early (<14 days), intermediate (14–30 days), or late (>30 days) after ventilation onset. The primary outcome was 180-day survival. Secondary outcomes included successful weaning at discharge, incidence of ventilation-associated pneumonia (VAP), post-discharge destinations, and PICU length of stay.
Results: Among 719 eligible children, 150 (20.9%) patients who received tracheotomy showed a significantly higher 180-day survival rate (aOR 1.98, [95%CI 1.23-3.26], P=0.01). No significant differences were observed in successful weaning (aOR 0.79, [95%CI 0.53-1.18], P=0.26) or VAP (aOR 0.77, [95%CI 0.51-1.14], P=0.2). Subgroup analysis revealed that tracheotomy improved 180-day survival in those with the central nervous system diseases and upper airway obstruction. Early tracheotomy was associated with shorter PICU stays compared to intermediate/late groups (median 43 [IQR 34-58] vs. 57 [IQR 34-65] vs. 65 [IQR 56-108], P<0.01).
Conclusions: Tracheotomy might be associated with improved 180-day survival in pediatric PMV patients, yet its timing showed no clear association with primary outcomes in our analysis. Given potential residual confounding, larger multicenter studies in more diverse populations are needed to verify and extend these findings.

引言：旨在评估气管切开术及其实施时机对长期机械通气（prolonged mechanical ventilation, PMV）儿科患者预后的影响。
方法：本研究为一项多中心回顾性研究，纳入2017年至2022年中国11家儿科重症监护病房（pediatric intensive care unit, PICU）的患者。纳入标准为：年龄介于29日龄至18岁，每日需接受至少6小时的机械通气，且该通气状态持续至少21天的患儿。将患儿分为气管切开组与非气管切开组；其中气管切开手术进一步按通气启动后的时机分层：早期（<14天）、中期（14~30天）及晚期（>30天）。主要结局指标为180天生存率；次要结局指标包括出院时成功脱机比例、呼吸机相关性肺炎（ventilation-associated pneumonia, VAP）发生率、出院后去向及PICU住院时长。
结果：在719名符合纳入标准的患儿中，150名（20.9%）接受了气管切开术，其180天生存率显著更高（校正比值比（adjusted odds ratio, aOR）1.98，95%置信区间（95% confidence interval, 95%CI）1.23~3.26，P=0.01）。两组在出院成功脱机比例（aOR 0.79，95%CI 0.53~1.18，P=0.26）及VAP发生率（aOR 0.77，95%CI 0.51~1.14，P=0.2）方面均无显著差异。亚组分析结果显示，对于中枢神经系统疾病及上气道梗阻患儿，气管切开术可提升其180天生存率。与中期、晚期气管切开组相比，早期气管切开组的PICU住院时长更短[中位数43，四分位距（interquartile range, IQR）34~58 vs. 57（IQR 34~65） vs. 65（IQR 56~108），P<0.01]。
结论：本研究结果显示，气管切开术或可改善儿科PMV患者的180天生存率，但手术时机与主要结局指标无明确关联。鉴于潜在的残余混杂偏倚，未来需开展纳入更多样化人群的大型多中心研究，以验证并拓展本研究结果。