Feasibility of shotgun metagenomics to assess microbial ecology of pediatric tracheostomy tubes

Wang, James C.; Bergeron, Mathieu; Andersen, Heidi Winterberg; Tikhtman, Raisa; Hunter, Tammy; Herr, Andrew B.; Alarcón, Alessandro de

doi:10.1002/lary.27356

Cited by 7 publications

(4 citation statements)

References 22 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Tracheal aspirates from patients with long-term tracheostomies showed reduced microbial diversity and increased abundance of organisms associated with healthcare-associated respiratory infections, such as Pseudomonas . While this has been demonstrated to a limited degree by genomic and non-genomic methods in long-term tracheostomised children previously, we were able to demonstrate for the first time in our serial cohort that the dysbiosis predates the tracheostomy tube placement 1 10 11 37 38. This supports previous microbiome research in children demonstrating changes in the airway microbiome with endotracheal intubation and ventilation 39.…”

Section: Discussionsupporting

confidence: 87%

Tracheostomy in children is associated with neutrophilic airway inflammation

Powell

Mather

et al. 2023

Thorax

View full text Add to dashboard Cite

BackgroundTracheostomies in children are associated with significant morbidity, poor quality of life, excess healthcare costs and excess mortality. The underlying mechanisms facilitating adverse respiratory outcomes in tracheostomised children are poorly understood. We aimed to characterise airway host defence in tracheostomised children using serial molecular analyses.MethodsTracheal aspirates, tracheal cytology brushings and nasal swabs were prospectively collected from children with a tracheostomy and controls. Transcriptomic, proteomic and metabolomic methods were applied to characterise the impact of tracheostomy on host immune response and the airway microbiome.ResultsChildren followed up serially from the time of tracheostomy up to 3 months postprocedure (n=9) were studied. A further cohort of children with a long-term tracheostomy were also enrolled (n=24). Controls (n=13) comprised children without a tracheostomy undergoing bronchoscopy. Long-term tracheostomy was associated with airway neutrophilic inflammation, superoxide production and evidence of proteolysis when compared with controls. Reduced airway microbial diversity was established pre-tracheostomy and sustained thereafter.ConclusionsLong-term childhood tracheostomy is associated with a inflammatory tracheal phenotype characterised by neutrophilic inflammation and the ongoing presence of potential respiratory pathogens. These findings suggest neutrophil recruitment and activation as potential exploratory targets in seeking to prevent recurrent airway complications in this vulnerable group of patients.

show abstract

Section: Discussionsupporting

confidence: 87%

Tracheostomy in children is associated with neutrophilic airway inflammation

Powell

Mather

et al. 2023

Thorax

View full text Add to dashboard Cite

show abstract

“…Tracheal aspirates from patients with long-term tracheostomies showed reduced microbial diversity and increased abundance of organisms associated with healthcare-associated respiratory infections, such as Pseudomonas. While this has been demonstrated to a limited degree by genomic and non-genomic methods in long-term tracheostomised children previously, we were able to demonstrate for the first time in our serial cohort that the dysbiosis predates the tracheostomy tube placement (1,10,11,40,41). This supports previous microbiome research in children demonstrating changes in the airway microbiome with endotracheal intubation and ventilation (42).…”

Section: Discussionsupporting

confidence: 86%

Tracheostomy in children promotes persistent neutrophilic airway inflammation

Powell

Mather

et al. 2022

Preprint

View full text Add to dashboard Cite

Background: Tracheostomies in children are associated with significant morbidity, poor quality of life, excess healthcare costs, and excess mortality. The underlying mechanisms facilitating adverse respiratory outcomes in tracheostomised children are poorly understood. We aimed to characterise airway host defence in tracheostomised children using serial molecular analyses. Methods: Tracheal aspirates, tracheal cytology brushings, nasal swabs and stool samples were prospectively collected from children with a tracheostomy and controls. Transcriptomic, proteomic, and metabolomic methods were applied to characterise the impact of tracheostomy on host immune response and the airway microbiome. Results: Children followed up serially from the time of tracheostomy up to three months post-procedure (n=9) were studied. A validation cohort of children with a long-term tracheostomy was also enrolled (n=24). Controls (n=13) comprised children without a tracheostomy undergoing bronchoscopy. Tracheostomy was associated with new, rapidly emergent and sustained airway neutrophilic inflammation, superoxide production and evidence of proteolysis when compared with controls. In contrast, reduced airway microbial diversity was established pre-tracheostomy and sustained thereafter. Conclusions: Childhood tracheostomy is associated with rapidly emergent and persistent airway neutrophil recruitment and activation, with sustained proteolysis and superoxide generation. These findings suggest neutrophil recruitment and activation as potential exploratory targets in seeking to prevent recurrent airway complications in this vulnerable group of patients.

show abstract

“…Patients with shortness of breath and history of tracheostomy should increase the awareness of the possibly of an A‐frame deformity. As with other sites of airway obstructions, carefully planning is required 11–20 …”

Section: Discussionmentioning

confidence: 99%

Management of A‐Frame Tracheal Deformity in Children With Endoscopic Resection Tracheoplasty

et al. 2020

Self Cite

View full text Add to dashboard Cite

Objectives Tracheal A‐frame deformity is a known consequence of tracheostomy that may lead to obstruction after decannulation. The goal of this study is to demonstrate the feasibility and success of endoscopic carbon dioxide (CO2) laser‐assisted tracheoplasty of tracheal A‐frame deformity in children. Methods Retrospective case series of symptomatic children with tracheal A‐frame deformity with no other site of airway obstruction (2016–2018). All patients underwent CO2‐laser assisted endoscopic resection tracheoplasty. Results Eight patients (six male) were included with a median age of 15.4 (IQR 12.3–17.9) years. Patients had a median of two previous open airway surgeries (IQR 1–2.5) and all patients had a history of tracheostomy with successful decannulation. Tracheal A‐frame deformity presented as dyspnea on exertion for all patients (n = 8, 100%). Obstructive sleep apnea was confirmed for all patients who underwent polysomnography (4/4, 100%). Median interval from decannulation to development of symptoms was 8.7 years (IQR 5.8–9.3). All patients sized with an age‐appropriate endotracheal tube despite the deformity. Endoscopic A‐frame tracheoplasty was successful for 7/8 (87.5%) patients and was performed with overnight observation for these patients (8/8, 100%). Unilateral A‐frame tracheoplasty was performed successfully for five patients (62.5%), bilateral A‐frame tracheoplasty was performed successfully for two patients (25.0%), and one patient (12.5%) did not have complete resolution of symptoms after bilateral A‐frame tracheoplasty due to multi‐level airway obstruction. Conclusions CO2 laser‐assisted tracheoplasty is an innovative endoscopic technique to relieve symptoms of airway obstruction for selected patients with tracheal A‐frame deformity although avoiding the morbidity and hospital stay duration associated with tracheal resection. Level of Evidence 4 Laryngoscope, 131:E719–E723, 2021

show abstract

Feasibility of shotgun metagenomics to assess microbial ecology of pediatric tracheostomy tubes

Cited by 7 publications

References 22 publications

Tracheostomy in children is associated with neutrophilic airway inflammation

Tracheostomy in children is associated with neutrophilic airway inflammation

Tracheostomy in children promotes persistent neutrophilic airway inflammation

Management of A‐Frame Tracheal Deformity in Children With Endoscopic Resection Tracheoplasty

Contact Info

Product

Resources

About