Use of Volume-Targeted Pressure Support in Children With Tracheostomies: A Single-Center Experience

Although the literature is limited, volume-targeted pressure support (VT-PS) ventilation has increasingly been used in children with tracheostomies.

To describe a single-center experience using invasive VT-PS in children with tracheostomies.

The Ventilator Care Program registry at Children's Hospital Colorado was used to identify subjects who underwent tracheotomy between 2015 and 2024. Children (≤ 21 years) with chronic mechanical ventilation for ≥ 14 consecutive days were included. Subjects were divided between the "VT-PS" (VT-PS ≥ 14 consecutive days or discharged on VT-PS) and "no VT-PS" (VT-PS < 14 consecutive days or discharged not on VT-PS) groups.

Three hundred twenty three subjects were mechanically ventilated via tracheostomy during the study period (VT-PS, n = 263 vs. no VT-PS, n = 60). In 2017, VT-PS surpassed synchronized intermittent mandatory ventilation-volume control (SIMV-VC) as the most common mode of ventilation when transitioning to a portable ventilator. VT-PS portable ventilator trials were more likely to be continued until discharge than SIMV-VC trials (52% vs. 27.9% p < 0.001). A transition to VT-PS when previously using another mode on a portable ventilator resulted in a reduction in the patient's respiratory rate (median 33.0 [IQR 25.0-41.5] vs. 31.0 [22.5-39.0], p < 0.001). There was no significant difference in the cumulative incidence of ventilator liberation or decannulation between the two groups.

Our institution's use of VT-PS has shown that this modality is well tolerated in most children with tracheostomies without adverse effects.