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Tracheostomy Outcomes in Children With Bronchopulmonary Dysplasia
Ada Cleary Sher1,2, Humra Shamim1, Jemma Maynard3
1Center for Regenerative Medicine, Abigail Wexner Research Institute, Nationwide Children's Hospital, Columbus, Ohio, USA.
Insights
Tracheostomy in children with bronchopulmonary dysplasia (BPD) had low mortality, but most experienced adverse events and readmissions. Further research is needed for airway interventions.
Area of Science:
- Pediatric Otolaryngology
- Pediatric Pulmonology
- Neonatology
Background:
- Bronchopulmonary dysplasia (BPD) is a chronic lung disease in infants, often requiring airway support.
- Tracheostomy is a common intervention for tracheostomy-dependent children with BPD.
- Quantifying tracheostomy-related outcomes in this vulnerable population is crucial for clinical management.
Purpose of the Study:
- To determine the morbidity, mortality, readmission rates, and airway intervention needs in children with BPD requiring tracheostomy.
- To analyze the types and frequency of tracheostomy-related complications.
- To identify factors influencing outcomes in this patient group.
Main Methods:
- Retrospective chart review of 76 infants with BPD who underwent tracheostomy.
- Data collected included patient characteristics, clinical encounters, and surgical visits.
- Follow-up of surviving patients to at least 2 years of age.
Main Results:
- Overall mortality was 30.3%, with one tracheostomy-related death.
- Tracheitis was the most frequent adverse event (21% short-term, 81% long-term).
- High rates of stomal granuloma (77%), airway stenosis (69%), and accidental decannulation (38%) were observed. 32% 30-day and 61% 2-year readmission rates were reported, primarily for tracheitis. 68% of survivors were decannulated by a median age of 3.1 years, with 85% requiring operative airway intervention, including 43% needing reconstruction.
Conclusions:
- Despite frequent adverse events and readmissions, tracheostomy-related morbidity was low in this BPD cohort.
- Comorbidities, BPD severity, and socioeconomic status did not significantly impact outcomes.
- Larger studies are recommended to further evaluate airway interventions and outcomes in pediatric tracheostomy patients with BPD.
Objective:
To quantify the tracheostomy-related morbidity and mortality, readmissions, and airway interventions in tracheostomy-dependent children with bronchopulmonary dysplasia (BPD).
Study Design:
Retrospective chart review.
Setting:
Tertiary care children's hospital.
Methods:
Infants with BPD who received tracheostomy by an otolaryngologist between January 2016 and December 2022 at a single institution were included. Surviving patients were followed to at least 2 years of age. Data were extracted from electronic medical records for patient characteristics, clinical encounters, and surgical visits.
Results:
There were 76 patients included in this study. The overall mortality was 30.3% (23/76) with one tracheostomy-related death. Tracheostomy occurred at a median 56 weeks postmenstrual age (PMA). Tracheitis was the most common short- and long-term adverse event (within the first postoperative week, 21%; after postoperative day 7, 81%). Other complications observed include stomal granuloma (77%), airway stenosis (69%), and accidental decannulation (38%). The 30-day and 2-year readmission rates were 32% and 61%, of which 61% and 76% were for tracheostomy-related causes, respectively. The most common reason for readmission over these time periods was tracheitis. Overall decannulation rate for surviving patients was 68%, and decannulation occurred at a median 3.1 years of age. Most surviving patients returned for operative airway intervention (85%); 43% required open airway reconstruction.
Conclusion:
Tracheostomy-related morbidity was low in this cohort despite a majority of patients experiencing multiple tracheostomy-related adverse events and readmissions. Patient comorbid conditions, BPD severity, and socioeconomic status were not significantly associated with outcomes. Larger studies are needed to assess the airway interventions and outcomes in this population.
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