Clinical features and outcomes associated with tracheostomy in congenital diaphragmatic hernia

Abstract

IntroductionThe purpose of this study was to examine the clinical features/outcomes associated with tracheostomy in infants with congenital diaphragmatic hernia (CDH).MethodsThe study population consisted of liveborn infants reported to the CDH Study Group registry between 2007 and 2017. Subjects were identified as having a tracheostomy if they were discharged or transferred to another hospital with tracheostomy and/or on mechanical ventilation. Multivariate mixed models were used for analyses.ResultsThe registry population consisted of 5434 subjects, of whom 230 (4.2%) underwent tracheostomy placement. Only 3830 (70.5%) infants survived until discharge/transfer. The median age of tracheostomy placement was 3.3 months (range, 1.3‐13.4 when known; n = 58 out of 154 survivors). The mortality rate among subjects with tracheostomy was 32.8% with a median of 37 days (range, 8‐189 when known; n = 32 out of 75 deceased) ensuing between tracheostomy placement and death. The clinical features found to be associated with increased odds ratio of tracheostomy placement included male sex, birth weight, 5‐minute APGAR score, defect size, liver in chest, ECMO use, cardiac abnormality, other congenital abnormalities, pulmonary hypertension, and the presence of a feeding tube. There was center variation in the rate of tracheostomy placement, which may be partially accounted for by disease severity, but not center size.ConclusionThere are several clinical features that are associated with increased likelihood of tracheostomy placement. Most deaths in subjects with tracheostomies occurred outside the immediate postoperative period. The utility of a standardized protocol for tracheostomy in infants with CDH should be considered.

Outcomes of congenital diaphragmatic hernia among preterm infants: inverse probability of treatment weighting analysis

“…Baroudi et al 24 reported that lower GA was a risk factor for tracheostomy in univariate analysis, but not in multivariate analysis. These ndings require additional cases and further investigations.…”

Chronic Lung Disease Following Neonatal Extracorporeal Membrane Oxygenation: A Single-Center Experience

“…Our incidence of tracheostomy in CDH survivors is in line with those described in prior publications (17). In patients with CDH, the need for ECMO has been associated with the degree of long-term pulmonary morbidity with an increased likelihood of tracheostomy placement (22,23). While prenatal risk stratification identifies severe cases, its correlation with longterm respiratory morbidity remains unknown (24) and postnatal identification of infants with irrecoverable lung hypoplasia that will develop severe CLD remains difficult (21).…”

Management advances for congenital diaphragmatic hernia: integrating prenatal and postnatal perspectives

“…Based on recent CDH Study Group data, mean ventilator duration was 17 days, and approximately half required some supplemental oxygen support at 30 days of life. Fortunately, tracheostomy is relatively uncommon (4%) and is employed in the most severe cases in which there were multiple failures to extubate or to wean from positive pressure ventilation ( 119 ).…”