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Bronchopulmonary dysplasia and ventilation-associated outcomes after pediatric tracheostomy
Stephen R Chorney1,2, Dylan R Beams1, Arushii Nadar1
1Department of Otolaryngology-Head and Neck Surgery, University of Texas Southwestern Medical Center, Dallas, Texas, USA.
Insights
Bronchopulmonary dysplasia (BPD) increases ventilation and tracheostomy duration in children. However, many with BPD eventually wean off ventilators and are decannulated, with pulmonary hypertension linked to increased mortality.
Area of Science:
- Pediatric Pulmonology
- Critical Care Medicine
- Neonatology
Background:
- Bronchopulmonary dysplasia (BPD) is a chronic lung disease in infants.
- Pulmonary hypertension (PH) is a serious complication that can affect children with BPD.
- Tracheostomy is often necessary for prolonged mechanical ventilation in these patients.
Purpose of the Study:
- To determine the time to ventilator liberation and tracheostomy decannulation in pediatric patients with BPD and PH.
- To compare outcomes between children with and without BPD after tracheostomy.
- To identify factors associated with mortality after tracheostomy.
Main Methods:
- Prospective cohort study of children (<18 years) undergoing tracheostomy between 2015-2021.
- Inclusion criteria: tracheostomy placement; data collected on BPD and PH diagnoses.
- Primary outcomes: time to ventilator liberation, decannulation, or death with tracheostomy.
Main Results:
- 42% of 303 children had BPD, younger and more likely to have PH.
- Children with BPD had longer ventilation (2.9 vs. 1.9 years) and decannulation times (3.4 vs. 1.8 years).
- BPD did not significantly prolong ventilator liberation or decannulation over time; PH associated with increased mortality (aHR=1.99), while BPD associated with decreased mortality (aHR=0.38).
Conclusions:
- BPD is linked to longer ventilation and tracheostomy duration but does not prevent eventual weaning and decannulation.
- Pulmonary hypertension, not BPD, is associated with increased mortality after tracheostomy.
- Tracheostomy outcomes in children with BPD and PH require careful consideration of comorbidities.
Objectives:
The objective of this study is to determine the time to ventilator liberation and decannulation after tracheostomy placement in children with bronchopulmonary dysplasia (BPD) and pulmonary hypertension.
Methods:
A prospective cohort study included all children (<18 years old) who underwent tracheostomy between 2015 and 2021 with or without a diagnosis of BPD. The primary outcomes were time to ventilator liberation, tracheostomy decannulation, or death with tracheostomy in place.
Results:
A total of 303 children met inclusion with a median (interquartile range [IQR]) age at tracheostomy of 6.9 (IQR: 4.0-49.5) months. A diagnosis of BPD was made for 42% (N = 127) and this group was younger (5.1 vs. 24.5 months, p < .001) and more often had pulmonary hypertension (68% vs. 24%, p < .001). Children with BPD spent a median of 2.9 years (IQR: 1.6-4.0) on ventilation compared to 1.9 years (IQR: 0.9-3.7) for children without BPD (p = .009). The time to decannulation was greater among children with BPD (3.4 vs. 1.8 years, p < .001). However, unadjusted estimates of ventilator liberation (hazard ratio [HR]: 1.05, 95% confidence interval [95% CI]: 0.77-1.44) and decannulation (HR: 1.11, 95% CI: 0.74-1.66) over time were not prolonged by BPD. Pulmonary hypertension was associated with shorter time to death (adjusted HR [aHR] = 1.99, 95% CI: 1.17-3.38, p = .01), while BPD was associated with longer time to death (aHR: 0.38, 95% CI: 0.22-0.67, p = .001).
Conclusion:
BPD is associated with increased ventilation and duration of tracheostomy but over time many children with BPD will wean off the ventilator and be decannulated. Pulmonary hypertension and not BPD is associated with increased time to death after tracheostomy.
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