Bronchopulmonary Dysplasia and Ventilation-Associated Outcomes After
Pediatric Tracheostomy
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.