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Tracheostomy in children is associated with neutrophilic airway inflammation
Jason Powell1,2, Steven Powell2, Michael W Mather2,3
1Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne, UK jason.powell@doctors.org.uk.
Insights
Childhood tracheostomy leads to airway inflammation and reduced microbial diversity, increasing risks for respiratory issues. Understanding these changes is key to preventing complications in young patients.
Area of Science:
- Pediatric Pulmonology
- Airway Inflammation
- Microbiome Research
Background:
- Tracheostomies in children are linked to severe health problems, including increased mortality.
- The biological reasons behind poor respiratory outcomes in tracheostomized children are not well understood.
- This study investigates the airway host defense mechanisms in children with tracheostomies.
Purpose of the Study:
- To characterize airway host defense in tracheostomized children.
- To analyze molecular changes in the airway post-tracheostomy.
- To understand the impact of tracheostomy on the airway immune response and microbiome.
Main Methods:
- Collected tracheal aspirates, cytology brushings, and nasal swabs from children with and without tracheostomies.
- Utilized transcriptomic, proteomic, and metabolomic analyses.
- Conducted serial molecular analyses over time.
Main Results:
- Long-term tracheostomy was associated with neutrophilic inflammation and increased superoxide production.
- Evidence of proteolysis was observed in children with long-term tracheostomies.
- Reduced airway microbial diversity was present before and after tracheostomy.
Conclusions:
- Childhood tracheostomy results in an inflammatory tracheal phenotype with neutrophilic inflammation.
- Potential respiratory pathogens are consistently present in the airways of tracheostomized children.
- Targeting neutrophil recruitment and activation may help prevent airway complications.
Background:
Tracheostomies in children are associated with significant morbidity, poor quality of life, excess healthcare costs and excess mortality. The underlying mechanisms facilitating adverse respiratory outcomes in tracheostomised children are poorly understood. We aimed to characterise airway host defence in tracheostomised children using serial molecular analyses.
Methods:
Tracheal aspirates, tracheal cytology brushings and nasal swabs were prospectively collected from children with a tracheostomy and controls. Transcriptomic, proteomic and metabolomic methods were applied to characterise the impact of tracheostomy on host immune response and the airway microbiome.
Results:
Children followed up serially from the time of tracheostomy up to 3 months postprocedure (n=9) were studied. A further cohort of children with a long-term tracheostomy were also enrolled (n=24). Controls (n=13) comprised children without a tracheostomy undergoing bronchoscopy. Long-term tracheostomy was associated with airway neutrophilic inflammation, superoxide production and evidence of proteolysis when compared with controls. Reduced airway microbial diversity was established pre-tracheostomy and sustained thereafter.
Conclusions:
Long-term childhood tracheostomy is associated with a inflammatory tracheal phenotype characterised by neutrophilic inflammation and the ongoing presence of potential respiratory pathogens. These findings suggest neutrophil recruitment and activation as potential exploratory targets in seeking to prevent recurrent airway complications in this vulnerable group of patients.
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