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Bronchopulmonary dysplasia and ventilation-associated outcomes after pediatric tracheostomy.
Chorney, Stephen R; Beams, Dylan R; Nadar, Arushii; Afolabi, Folashade; Gelfand, Andrew; Brooks, Rebecca; Kou, Yann-Fuu; Johnson, Romaine F.
Afiliación
  • Chorney SR; Department of Otolaryngology-Head and Neck Surgery, University of Texas Southwestern Medical Center, Dallas, Texas, USA.
  • Beams DR; Department of Pediatric Otolaryngology, Children's Health, Dallas, Texas, USA.
  • Nadar A; Department of Otolaryngology-Head and Neck Surgery, University of Texas Southwestern Medical Center, Dallas, Texas, USA.
  • Afolabi F; Department of Otolaryngology-Head and Neck Surgery, University of Texas Southwestern Medical Center, Dallas, Texas, USA.
  • Gelfand A; Department of Pediatrics, Division of Pediatric Pulmonology and Sleep Medicine, University of Texas Southwestern Medical Center, Dallas, Texas, USA.
  • Brooks R; Department of Pediatrics, Division of Pediatric Pulmonology and Sleep Medicine, University of Texas Southwestern Medical Center, Dallas, Texas, USA.
  • Kou YF; Department of Otolaryngology-Head and Neck Surgery, University of Texas Southwestern Medical Center, Dallas, Texas, USA.
  • Johnson RF; Department of Pediatric Otolaryngology, Children's Health, Dallas, Texas, USA.
Pediatr Pulmonol ; 2024 Sep 12.
Article en En | MEDLINE | ID: mdl-39267435
ABSTRACT

OBJECTIVES:

The objective of this study is 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 outcomes were time to ventilator liberation, tracheostomy decannulation, or death with tracheostomy in place.

RESULTS:

A total of 303 children met inclusion with a median (interquartile range [IQR]) age at tracheostomy of 6.9 (IQR 4.0-49.5) months. A diagnosis of BPD was made for 42% (N = 127) and this group was younger (5.1 vs. 24.5 months, p < .001) and more often had pulmonary hypertension (68% vs. 24%, p < .001). Children with BPD spent a median of 2.9 years (IQR 1.6-4.0) on ventilation compared to 1.9 years (IQR 0.9-3.7) for children without BPD (p = .009). The time to decannulation was greater among children with BPD (3.4 vs. 1.8 years, p < .001). However, unadjusted estimates of ventilator liberation (hazard ratio [HR] 1.05, 95% confidence interval [95% CI] 0.77-1.44) and decannulation (HR 1.11, 95% CI 0.74-1.66) over time were not prolonged by BPD. Pulmonary hypertension was associated with shorter time to death (adjusted HR [aHR] = 1.99, 95% CI 1.17-3.38, p = .01), while BPD was associated with longer time to death (aHR 0.38, 95% CI 0.22-0.67, p = .001).

CONCLUSION:

BPD is associated with increased ventilation and duration of tracheostomy but over time many children with BPD will wean off the ventilator and be decannulated. Pulmonary hypertension and not BPD is associated with increased time to death after tracheostomy.
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Texto completo: 1 Colección: 01-internacional Base de datos: MEDLINE Idioma: En Revista: Pediatr Pulmonol Asunto de la revista: PEDIATRIA Año: 2024 Tipo del documento: Article País de afiliación: Estados Unidos Pais de publicación: Estados Unidos
Texto completo
Añadir a Mi BVS
Imprimir
XML
PubMed Links
Buscar en Google

Texto completo: 1 Colección: 01-internacional Base de datos: MEDLINE Idioma: En Revista: Pediatr Pulmonol Asunto de la revista: PEDIATRIA Año: 2024 Tipo del documento: Article País de afiliación: Estados Unidos Pais de publicación: Estados Unidos