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Bronchopulmonary Dysplasia and Ventilation-Associated Outcomes After Pediatric Tracheostomy
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  • Romaine Johnson,
  • Dylan Beams,
  • Arushii Nadar,
  • Folashade A. Afolabi,
  • Andrew Gelfand,
  • Rebecca Brooks,
  • Stephen R. Chorney,
  • Yann-Fuu Kou
Romaine Johnson
The University of Texas Southwestern Medical Center

Corresponding Author:romaine.johnson@utsouthwestern.edu

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Dylan Beams
The University of Texas Southwestern Medical Center
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Arushii Nadar
The University of Texas Southwestern Medical Center
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Folashade A. Afolabi
The University of Texas Southwestern Medical Center Department of Pediatrics
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Andrew Gelfand
The University of Texas Southwestern Medical Center Department of Pediatrics
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Rebecca Brooks
The University of Texas Southwestern Medical Center
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Stephen R. Chorney
The University of Texas Southwestern Medical Center
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Yann-Fuu Kou
The University of Texas Southwestern Medical Center
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Abstract

Objectives: 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 outcome measures were times to mechanical ventilator liberation, tracheostomy decannulation, or death with tracheostomy in place. Patient demographics, associated comorbidities, and outcomes were compared between groups. Results: A total of 318 children met inclusion with a median (interquartile, IQR) age at tracheostomy of 6.9 (IQR: 4.1 – 49.2) months and 54% (N=170) were male. A diagnosis of BPD was made for 43% (N=136) and this group was younger at tracheostomy placement (5.2 vs. 24.5 months, P<.001) and more often had pulmonary hypertension (65% vs. 24%, P<.001) than children without BPD. Children with BPD spent a median of 2.92 years (IQR: 1.60 – 4.03) on mechanical ventilation compared to 1.84 years (IQR: 0.84 – 3.60) for children without BPD ( P=.003). Unadjusted estimation of time to decannulation was longer for children with BPD (HR=0.92, 95% CI: 0.62 – 1.38). The adjusted survival analysis for time to mortality included pulmonary hypertension as a variable of significance (aHR= 2.5, 95% CI: 1.43 – 4.40). Conclusion: The presence of BPD is associated with an increased duration of mechanical ventilation and time to tracheostomy decannulation. Pulmonary hypertension is associated with an increased mortality risk among this vulnerable population of children.
Submitted to Pediatric Pulmonology
05 Mar 2024Assigned to Editor
05 Mar 2024Submission Checks Completed
26 Apr 2024Review(s) Completed, Editorial Evaluation Pending
19 Jun 20241st Revision Received
30 Jul 2024Review(s) Completed, Editorial Evaluation Pending
02 Aug 2024Editorial Decision: Revise Minor
17 Aug 20242nd Revision Received
20 Aug 2024Review(s) Completed, Editorial Evaluation Pending
20 Aug 2024Submission Checks Completed
20 Aug 2024Assigned to Editor
20 Aug 2024Reviewer(s) Assigned
31 Aug 2024Editorial Decision: Accept