Tracheostomy in infants with severe bronchopulmonary dysplasia: A review

Akangire, Gangaram; Manimtim, Winston M

doi:10.3389/fped.2022.1066367

Cited by 5 publications

(9 citation statements)

References 62 publications

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“…This study demonstrated a similar overall mortality rate to that reported in other studies of infants and young children with severe BPD and tracheostomies 9 . In survival analysis, we identified that most deaths occurred in the first 1 year following tracheostomy placement.…”

Section: Discussionsupporting

confidence: 87%

“…37,[43][44][45][46][47] This study demonstrated a similar overall mortality rate to that reported in other studies of infants and young children with severe BPD and tracheostomies. 9 In survival analysis, we identified that most deaths occurred in the first 1 year following tracheostomy placement. BPD in a multicenter study; 23 there was no racial difference in probability of tracheostomy placements in that study.…”

Section: Discussionmentioning

confidence: 99%

“…5 For those who require tracheostomy placement for chronic respiratory support, the weaning of support is widely viewed as a sign of improving pulmonary function, with liberation from ventilation generally expected by 24-30 months. [6][7][8][9] Subsequent decannulation is also anticipated, and is viewed as a sign of airway growth and patency and respiratory stability. However, only one-third to half of children with BPD and tracheostomies follow this trajectory of lung health improvement.…”

Section: Introductionmentioning

confidence: 99%

“…Among young children with BPD, the expected respiratory course is one of improvement in lung function with time and alveolar growth 5 . For those who require tracheostomy placement for chronic respiratory support, the weaning of support is widely viewed as a sign of improving pulmonary function, with liberation from ventilation generally expected by 24–30 months 6–9 . Subsequent decannulation is also anticipated, and is viewed as a sign of airway growth and patency and respiratory stability.…”

Section: Introductionmentioning

confidence: 99%

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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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Section: Discussionsupporting

confidence: 87%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

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

Steuart,

Pan,

Woolums

et al. 2023

Pediatric Pulmonology

View full text Add to dashboard Cite

show abstract

“…37,[43][44][45][46][47] This study demonstrated a similar overall mortality rate to that reported in other studies of infants and young children with severe BPD and tracheostomies. 9 In survival analysis, we identified that most deaths occurred in the first 1 year following tracheostomy placement. In our adjusted analyses, children of non-White, non-Black race had a nearly threefold higher risk of 3-year mortality across predictor groups as compared with white peers; notably, the other covariates of sex, insurance type, and CCCs included in this model did not reach statistical significance.…”

Section: Discussionmentioning

confidence: 99%

Respiratory Culture Growth and 3-Year Lung Health Outcomes in Children with BPD and Tracheostomies

Steuart

Pan

Woolums

et al. 2023

Preprint

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Background: While 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. Objective: To determine if respiratory culture growth of pathogenic organisms is associated with ongoing need for respiratory support, decannulation, and death at 3 years post-tracheostomy placement in children with BPD and tracheostomies. Methods: This single center, retrospective cohort study included infants and children with BPD and tracheostomies placed 2010-2018 and >1 respiratory culture obtained in 36 months post-tracheostomy. 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 post-tracheostomy. We used Poisson regression models to examine the relationship between respiratory organisms and outcomes, controlling for patient-level covariates and within-patient clustering. Results: Among 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 risk of decannulation (aRR 0.48, 95% CI 0.23-0.98). Chronic P. aeruginosa was associated with lower survival probability. Conclusion: Our 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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Factors associated with tracheostomy decannulation in infants with bronchopulmonary dysplasia

Lloyd,

Behzadpour,

Rana

et al. 2023

International Journal of Pediatric Otorhinolaryngology

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Tracheostomy in infants with severe bronchopulmonary dysplasia: A review

Cited by 5 publications

References 62 publications

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

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

Respiratory Culture Growth and 3-Year Lung Health Outcomes in Children with BPD and Tracheostomies

Factors associated with tracheostomy decannulation in infants with bronchopulmonary dysplasia

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