Abstract
Objectives
To characterize pediatric patients undergoing tracheotomy for bronchopulmonary dysplasia (BPD). To examine the effects of tracheomalacia on tracheostomy outcomes in these patients.
Methods
The medical records of 95 patients with BPD who underwent tracheotomy in an academic tertiary care children's hospital over 8 years were evaluated for gestational age, birthweight, ethnicity, gender, co-morbid conditions, duration of ventilator support, duration of hospitalization, number of failed extubation attempts before tracheotomy, age at tracheotomy, and time to decannulation.
Results
The average gestational age was 28.9 weeks and the average postnatal age at tracheotomy was 27.6 weeks after having failed an average of 1.2 extubation attempts. The patients averaged 268.2 days of hospitalization, with 41.6% still requiring ventilator support and 57.1% still having tracheostomy at the end of the study. Of 27 patients with tracheomalacia, 4 (15%) were eventually decannulated vs. 36 of 68 patients without tracheomalacia (53%). The average time to decannulation among patients with tracheomalacia was 27.4 months and without tracheomalacia was 25.7 months. Decreased gestational age correlated with increased time to decannulation (Cox regression analysis, p=0.035). Of patients with genetic anomalies, 22.7% were eventually decannulated vs. 49.3% of patients without genetic anomalies (p = 0.027).
Conclusions
This study describes the characteristics of patients undergoing tracheotomy for BPD and begins to clarify the relationship between BPD and tracheomalacia. The presence of tracheomalacia in patients with BPD correlates with decreased likelihood of decannulation, but does not significantly affect time to decannulation. As such, tracheomalacia may be an independent risk factor for worse tracheostomy prognosis.
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