(110) Optimizing the Transition to Tracheostomy in Infants with Bronchopulmonary Dysplasia

Background: Bronchopulmonary dysplasia (BPD) is the most common sequelae of prematurity. Infants with severe BPD are at risk of requiring tracheostomies and home mechanical ventilation. Improper sizing of tracheostomy tubes can lead to various complications, including improper ventilation, and tracheal injury, but sizing can be difficult, and it is unclear which risk factors may predict the need for a longer tracheostomy. We aimed to determine predictive factors of tracheostomy complications.

Objectives: To determine factors predictive of sizing difficulties with tracheostomies and post-tracheostomy complications in infants with severe bronchopulmonary dysplasia.

Design/Methods: We performed a retrospective chart review from 2018-2024 at a single Level IV NICU in the Midwest. We included all infants born before 32 weeks of gestation with severe BPD requiring tracheostomy and excluded all infants with congenital airway anomalies. Demographic data was collected, but we also manually collected preoperative variables such as weight, length, ventilator settings 24 hours prior to tracheostomy, the need for paralysis prior to tracheostomy, and if there was documented malacia. The length, size, and style of the tracheostomy was documented. We collected post-operative data including ventilator settings, need for bedside endoscopy, imaging, and tracheostomy changes. Additionally, we counted the number of desaturation events requiring positive pressure ventilation (PPV) within 7 days preoperatively and 7 days postoperatively. We defined postoperative complications as any PPV event within 7 days after tracheostomy. We also collected discharge data including disposition, length of stay, weight, and discharge tracheostomy data. Mann-Whitney and Chi Square statistical analysis will be done to analyze this data and determine if there are predictive factors of postoperative complications.

Results:

Conclusions: