386 - Factors Influencing Respiratory Outcomes Post-Tracheostomy in Severe BPD

Publication Number: 1370.386

Margaret Kvale, Medical College of Wisconsin, Wauwatosa, WI, United States; Alicia Sprecher, Medical College of Wisconsin, Milwaukee, WI, United States; Rebecca Steuart, Medical College of Wisconsin, Milwaukee, WI, United States; William J. Scott, Medical College of Wisconsin, Milwaukee, WI, United States; Joanne Lagatta, Medical College of Wisconsin, Milwaukee, WI, United States; Kathryn EK. Berlin, Medical College of Wisconsin, Milwaukee, WI, United States

Background: The incidence of tracheostomy is increasing over time as more infants with severe bronchopulmonary dysplasia (BPD) survive. While tracheostomy is often a step towards discharge home, some infants temporarily worsen after tracheostomy placement. Understanding risk factors for postoperative decompensation is essential for counseling and risk stratification.

Objective: To identify risk factors for worsening respiratory status after tracheostomy in infants with BPD.

Design/Methods: Single-center retrospective cohort study of infants with severe BPD requiring tracheostomy from 2019 to 2024. Data included demographics; desaturation events requiring positive-pressure ventilation (PPV); endoscopy-documented airway malacia; need for non-perioperative neuromuscular blockade after 36 weeks postmenstrual age (PMA); tracheostomy change before post-operative day 5; and code events after tracheostomy. Mode of respiratory support and respiratory severity scores (RSS) at 36- and 40-weeks PMA, the day before tracheostomy, and 14 days post-tracheostomy were collected. Change in respiratory status was defined by the change in RSS from the day before tracheostomy to two weeks after tracheostomy. Bivariate analysis evaluated characteristics associated with RSS change. This project was exempted by the Institutional Review Board of Children’s Wisconsin.

Results: In total, 42 infants with severe BPD requiring tracheostomy were identified whose characteristics are described in Table 1. Following tracheostomy, 43% of patients had higher RSS values, with median scores increasing from 5.1 [2.9-5.2] pre-tracheostomy to 6.6 [3.5-8.1] two weeks afterward, a median rise of 1.5 points [0.4-1.7]. Children with higher post-tracheostomy RSS had higher pre-tracheostomy RSS at 36 weeks PMA, were more likely to be receiving NAVA support at 36 weeks and had greater use of neuromuscular blockade after 36 weeks (Figure 1). Children with higher RSS post-tracheostomy underwent tracheostomy placement at a later PMA (p = 0.007) and had a higher incidence of code events and desaturations requiring PPV within 14 days (Figure 2), although this did not reach statistical significance.

Conclusion(s): Nearly half of infants with BPD demonstrated a higher RSS two weeks after tracheostomy placement, which was more prevalent among those with earlier markers of respiratory instability and higher PMA at time of tracheostomy. These findings can inform preoperative counseling and risk stratification for tracheostomy placement in infants with BPD.

Table 1: Cohort Characteristics
Table 1.pdf

Figure 1: Pre-Tracheostomy Variables
Figure 1_final.pdfPre-tracheostomy covariates in infants with severe BPD. Evaluated variables include use of invasive NAVA at 36 and 40 weeks PMA, presence of airway malacia on endoscopy by pulmonology/otolaryngology, desaturation events requiring positive pressure ventilation within 7 days before tracheostomy, and need for neuromuscular blockade for respiratory decompensation after 36 weeks PMA (excluding the postoperative tracheostomy period). Respiratory Severity Scores (RSS) at 36 and 40 weeks PMA are also shown. Variables expressed as counts or percentages were analyzed using the Chi-square test, while continuous variables were analyzed using the Student’s t-test.

Figure 2: Outcome Variables After Tracheostomy
Figure 2_final.pdfPost-tracheostomy outcomes in infants with severe BPD. Assessed outcomes include undergoing a tracheostomy change within the first five postoperative days, code events within 14 days, and desaturation events requiring positive pressure ventilation within 14 days. Variables were analyzed using the Chi-square test.