Effect of tracheostomy timing in premature infants

To examine if timing of tracheostomy placement in premature infants affects the rates of decannulation and length of time required for mechanical ventilatory support.

Consecutive case series with chart review of premature patients born at a gestational age of 36 weeks or less at a tertiary-care, academic children's hospital who underwent tracheostomy placement between July 1, 2007 and December 31, 2010 for failure to extubate and chronic lung disease of prematurity. Last follow-up data reviewed was January 1, 2013.

43 patients were identified. 32 patients (74.4%) were able to be weaned from mechanical ventilation by the end of follow-up period, and the average time that elapsed between tracheostomy placement and weaning from mechanical ventilator support was 17.9 months. 19 patients (44.2%) were able to be decannulated, and of those patients, the amount of time between tracheostomy placement and decannulation was 27.9 months. No statistical significance was found in the relationship between tracheostomy timing placement and ability to wean from mechanical ventilator support or decannulate. For those patients able to wean from mechanical ventilator support and get decannulated, no difference in the amount of time and tracheostomy timing was found. Earlier premature patients tended to undergo tracheostomy later in life.

Decisions regarding tracheostomy placement should be individualized. We were unable to detect a relationship between tracheostomy timing and the ability or duration for premature infants with chronic lung disease of prematurity to wean from mechanical ventilator support or successfully decannulate.