Abstract
Objective To report on the population of infants receiving a tracheostomy, identify acute post-tracheostomy
clinical decompensations, and seek predictive markers associated with acute complications
following the placement of a tracheostomy.
Study Design Retrospective deidentified clinical data was provided by the Infant Pulmonary Data
Repository at Children's Mercy Hospital, Kansas City. Data from infants undergoing
tracheostomy from January 1, 2008 through September 30, 2016 were divided into one
of two study groups based on clinical correlations: (1) no acute decompensations within
72 hours post-tracheostomy or (2) acute clinical decompensation defined as sustained
escalation of respiratory care within the 72 hours following tracheostomy.
Results Thirty-four percent of infants undergoing tracheostomy during this period developed
acute post-tracheostomy clinical decompensations. Elevated pre-tracheostomy positive
end expiratory pressure, mean airway pressure, and echocardiogram findings suggestive
of pulmonary hypertension (PH) or ventricular dysfunction were associated with acute
post-tracheostomy clinical decompensations. Additionally acute post-tracheostomy clinical
decompensation was associated with higher rate of death prior to discharge.
Conclusion Infants requiring higher respiratory support and infants with PH or ventricular dysfunction
are at risk of acute post-tracheostomy clinical decompensation, thus identifying these
patients may lead to better pre-tracheostomy counseling and potentially targeted treatments
to decrease this risk.
Keywords
bronchopulmonary dysplasia - tracheostomy - pulmonary hypertension - pulmonology
