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Outcomes of Ventilator-Dependent Children With Severe Bronchopulmonary Dysplasia and Tracheobronchomalacia

Manvi Bansal1, Winston M Manimtim2, Amit Agarwal3

  • 1Pulmonology and Sleep Medicine, Children's Hospital of Los Angeles, Los Angeles, California, USA.

Pediatric Pulmonology
|April 17, 2025
PubMed

Insights

Tracheobronchomalacia (TBM) did not impact ventilator support, liberation, or decannulation in infants with bronchopulmonary dysplasia (BPD). Other BPD factors likely influence these outcomes, necessitating further research.

Area of Science:

  • Pediatric Pulmonology
  • Neonatology
  • Respiratory Medicine

Background:

  • Bronchopulmonary dysplasia (BPD) is a chronic lung disease affecting premature infants, often requiring long-term mechanical ventilation.
  • Tracheobronchomalacia (TBM), a condition characterized by airway collapse, can coexist with BPD and complicate respiratory management.
  • Understanding the interplay between BPD and TBM is crucial for optimizing care and improving outcomes in ventilator-dependent children.

Purpose of the Study:

  • To investigate the prevalence of TBM in a cohort of ventilator-dependent infants and children with BPD.
  • To evaluate the impact of TBM on the requirement for mechanical ventilation, the duration of ventilator dependence, and the rate of tracheostomy decannulation.
  • To compare respiratory outcomes between BPD patients with and without TBM.

Main Methods:

  • Retrospective review of demographic and clinical data from 154 ventilator-dependent infants and children with BPD.
  • Data collected from 12 centers participating in the outpatient BPD Collaborative registry (2016-2021).
  • Comparison of respiratory outcomes between patients with documented TBM (48.7%) and those without TBM.

Main Results:

  • No significant differences in ventilator support needs, time to liberation from ventilation, or tracheostomy decannulation rates were observed between TBM and non-TBM groups.
  • The non-TBM group exhibited a lower mean birth weight (p=0.006) and a higher incidence of Nissen fundoplication (p=0.006) and diuretic use (p=0.007).
  • Despite these differences, overall respiratory outcomes were comparable, suggesting TBM may not be the primary driver of prolonged ventilator dependence in this population.

Conclusions:

  • The presence of TBM does not appear to significantly alter ventilator support requirements, ventilator liberation, or tracheostomy decannulation rates in ventilator-dependent infants with BPD.
  • The study suggests that other components of BPD disease pathology may play a more critical role in determining the need for tracheostomy and ultimate respiratory outcomes.
  • A prospective, multicenter study is recommended to further elucidate the impact of TBM in severe BPD.
Abstract

Keywords:
bronchopulmonary dysplasiamalaciatracheostomyventilator

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