Introduction
Bronchopulmonary dysplasia (BPD) is the most common chronic lung disease of prematurity with an estimated 10,000 to 15,000 infants diagnosed with BPD annually in the United States. Despite changes in diagnostic criteria, most studies suggest that both the incidence and prevalence have remained stable.1,2 Patients diagnosed with BPD necessitate increased healthcare resources and often require long-term respiratory support. Additionally, comorbid medical conditions such as pulmonary hypertension and other sequelae of prematurity can influence their need for further care.3-9
Tracheostomy placement is often considered for children with BPD.10,11 These patients require prolonged hospitalization and long-term intensive care given their medical complexity.12-16 Research on tracheostomy outcomes for children with BPD has yielded varied findings on morbidity and mortality, perhaps due to the influence of comorbidities.17-20 The relationship between patient characteristics, rates of tracheostomy, hospital readmissions, and mortality have been described for children with BPD.21,22 The increasing use of tracheostomy in this population has resulted in single-instution series on duration of ventilator support and tracheostomy dependence.17,18,20,23 However, there have been limited prospective studies looking at long-term ventilator and tracheostomy outcomes among children with BPD.
The Children’s Health Airway Management Program (CHAMP) prospectively follows all children who had tracheostomy placement at Children’s Medical Center Dallas. Children are enrolled in a registry until decannulation, death, or reaching 21 years of age. This dataset has been used previously to publish work related to perioperative outcomes, socioeconomic and racial disparities, as well as tracheostomy caregiver quality of life.24-27 CHAMP is therefore well-suited to explore longterm outcomes after tracheostomy surgery in children with BPD. The primary objective of this study is to examine the relationship between the presence of BPD and pulmonary hypertension with a patient’s time to ventilator liberation as well as eventual decannulation. Based on prior data,28 we hypothesized that children diagnosed with BPD and resultant secondary pulmonary hypertension would have an increased duration of mechanical ventilation and thus a prolonged time to tracheostomy decannulation.