Respiratory, growth, and survival outcomes of infants with tracheostomy and ventilator dependence

Akangire, Gangaram; Taylor, Jane B.; McAnany, Susan; Noel-Macdonnell, Janelle R; Lachica, Charisse; Sampath, Venkatesh; Manimtim, Winston M

doi:10.1038/s41390-020-01183-x

Cited by 20 publications

(55 citation statements)

References 34 publications

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“…The total decannulation rate (24.33%) of our population was comparable to those reported in the literature (30%–31%) 7,23 . Time to decannulation (median IQR = 2.66 ± 2.07 years) was comparable to that of Akangire et al (33.8 ± 19.3 months) 7 . The lack of difference in decannulation rate between neonatal and infantile groups and time to decannulation is consistent with Cheng et al who reported that there was no relationship found between tracheostomy timing and ability to be decannulated among premature infants with chronic lung disease 24 …”

Section: Discussionsupporting

confidence: 87%

“…When the respiratory system is given time to mature, patients are able to overcome the need for support and become ventilator independent and are likely to be candidates for decannulation 6,22 . The total decannulation rate (24.33%) of our population was comparable to those reported in the literature (30%–31%) 7,23 . Time to decannulation (median IQR = 2.66 ± 2.07 years) was comparable to that of Akangire et al (33.8 ± 19.3 months) 7 .…”

Section: Discussionsupporting

confidence: 77%

“…There are few directly comparable studies to examine long‐term mortality rate infant tracheostomy patients given that the majority of studies vary in range of ages included in analysis, tracheotomy indications, and length of follow‐up. Our mortality rate (15.13%) falls within the lower end of the studies on preterm and infant tracheostomy, who cite a mortality rate ranging from 14.2% to 23.53% 4,7,25,26 . However, it remains at upper limit of overall all‐cause mortality rates associated with all ages of pediatric tracheostomy ranging from 1.5% to 18.9% 11,26–30 .…”

Section: Discussionmentioning

confidence: 64%

“…This population appeared distinct from those undergoing tracheotomy after 1 year of age, likely attributable to higher rates of respiratory failure, bronchopulmonary dysplasia (BPD), and ventilator dependence. Few studies have described infants undergoing a tracheotomy, prompting our focused investigation into long‐term outcomes associated with tracheotomy occurring in the first year of life 7 …”

Section: Introductionmentioning

confidence: 99%

“…Few studies have described infants undergoing a tracheotomy, prompting our focused investigation into long-term outcomes associated with tracheotomy occurring in the first year of life. 7 Preterm infants have shown overall improvements with morbidity and mortality over the last 20 years. 8 However, there is a correlating rise in incidence of BPD and tracheotomies among this population.…”

Section: Introductionmentioning

confidence: 99%

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Comparing Long‐Term Outcomes in Tracheostomy Placed in the First Year of Life

et al. 2021

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Objectives//Hypothesis To characterize long‐term outcomes in pediatric patients requiring tracheotomy in the first year of life. Study Design Retrospective case series. Methods A retrospective longitudinal registry of tracheostomy patients was queried for patients who underwent tracheotomy from birth to 11 months. Primary outcomes were decannulation and survival. Secondary outcomes included neurocognitive quality of life assessed with the PedsQL Family Impact Module (scored from worst to best, 0 to 100 points). Results The study included 337 children. Thirty (8.90%) were neonates and 307 (91.10%) were infants. The population was 56.08% male (n = 189), and the racial and ethnicity composition were equally distributed (29.97% White, 31.45% Black, and 31.16% Hispanic). Significant differences between neonates and postneonates included birth weight in grams (2,731.40 vs. 1,950.44, P < .05), extreme prematurity (13.33% vs. 38.88%, P = .01), upper airway obstruction (80.00% vs. 42.67%, P < .05), and the need for mechanical ventilation (40.00% vs. 83.71%, P < .05). Despite these differences, long‐term outcomes were similar: decannulation (X2 = 2.19, P = .14), death (X2 = 2.63, P = .11), and neurocognitive quality of life (X2 = 2.63, P = .27). Having a child with a tracheostomy caused the most problems with being physically tired (mean = 75.32 ± 3.90), emotional frustration (mean = 77.31 ± 5.05), and worry (mean standard deviation = 74.23 ± 6.48). Conclusion There were demographic differences between neonatal and infantile tracheostomy patients, but they did not affect long‐term outcomes. The presence of a tracheostomy caused a significant impact on a family's quality of life. Level of Evidence 3 Laryngoscope, 131:2115–2120, 2021

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Section: Discussionsupporting

confidence: 87%

Section: Discussionsupporting

confidence: 77%

Section: Discussionmentioning

confidence: 64%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 3 more Smart Citations

Comparing Long‐Term Outcomes in Tracheostomy Placed in the First Year of Life

et al. 2021

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Outcomes of infants with severe bronchopulmonary dysplasia who received tracheostomy and home ventilation

Akangire

Lachica

Noel-Macdonnell

et al. 2022

Pediatric Pulmonology

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Objective To describe the survival rate, timing of liberation from the ventilator, and factors favorable for decannulation among infants with severe bronchopulmonary dysplasia (sBPD) who received tracheostomy. Methods Demographics and clinical outcomes were obtained through retrospective chart review of 98 infants with sBPD who were born between 2004 and 2017, received tracheostomy at <1 year of age, and were followed in the Infant Tracheostomy and Home Ventilator clinic up to 4 years of age. Results The number of infants with sBPD who received tracheostomy increased significantly over the study period. The median age at tracheostomy was 4 months (IQR 3, 5) or 43 weeks corrected gestational age; the median age at NICU discharge was 7 months (IQR 6, 9). At 48 months of age, all subjects had been liberated from the ventilator, at a median age of 24 months (IQR 18, 29); 52% had been decannulated with a median age at decannulation of 32 months (IQR 26, 39). Only 1 (1%) infant died. Multivariate logistic regression showed infants who were White, liberated from the ventilator by 24 months of age and have public insurance had significantly greater odds of being decannulated by 48 months of age. Tracheobronchomalacia was associated with decreased odds of decannulation. Conclusion Infants with sBPD who received tracheostomy had an excellent survival rate. Liberation from home ventilation and decannulation are likely to occur by 4 years of age.

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Respiratory culture growth and 3‐years lung health outcomes in children with bronchopulmonary dysplasia and tracheostomies

Steuart,

Pan,

Woolums

et al. 2023

Pediatric Pulmonology

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BackgroundWhile bacteria identification on respiratory cultures is associated with poor short‐term outcomes in children with bronchopulmonary dysplasia (BPD) and tracheostomies, the influence on longer‐term respiratory support needs remains unknown.ObjectiveTo determine if respiratory culture growth of pathogenic organisms is associated with ongoing need for respiratory support, decannulation, and death at 3 years posttracheostomy placement in children with BPD and tracheostomies.MethodsThis single center, retrospective cohort study included infants and children with BPD and tracheostomies placed 2010–2018 and ≥1 respiratory culture obtained in 36 months posttracheostomy. Primary predictor was any pathogen identified on respiratory culture. Additional predictors were any Pseudomonas aeruginosa and chronic P. aeruginosa identification. Outcomes included continued use of respiratory support (e.g., oxygen, positive pressure), decannulation, and death at 3 years posttracheostomy. We used Poisson regression models to examine the relationship between respiratory organisms and outcomes, controlling for patient‐level covariates and within‐patient clustering.ResultsAmong 170 children, 59.4% had a pathogen identified, 28.8% ever had P. aeruginosa, and 3.5% had chronic P. aeruginosa. At 3 years, 33.1% of alive children required ongoing respiratory support and 24.8% achieved decannulation; 18.9% were deceased. In adjusted analysis, any pathogen and P. aeruginosa were not associated with ongoing respiratory support or mortality. However, P. aeruginosa was associated with decreased decannulation probability (adjusted risk ratio 0.48, 95% CI 0.23–0.98). Chronic P. aeruginosa was associated with lower survival probability.ConclusionOur findings suggest that respiratory pathogens including P. aeruginosa may not promote long‐term respiratory dysfunction, but identification of P. aeruginosa may delay decannulation.

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Respiratory, growth, and survival outcomes of infants with tracheostomy and ventilator dependence

Cited by 20 publications

References 34 publications

Comparing Long‐Term Outcomes in Tracheostomy Placed in the First Year of Life

Comparing Long‐Term Outcomes in Tracheostomy Placed in the First Year of Life

Outcomes of infants with severe bronchopulmonary dysplasia who received tracheostomy and home ventilation

Respiratory culture growth and 3‐years lung health outcomes in children with bronchopulmonary dysplasia and tracheostomies

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