Link: https://www.ncbi.nlm.nih.gov/pubmed/31502766

Pediatr Pulmonol. 2019 Sep 10. doi: 10.1002/ppul.24516. [Epub ahead of print]
Clinical features and outcomes associated with tracheostomy in congenital diaphragmatic hernia.
Al Baroudi S1, Collaco JM1, Lally PA2, Harting MT2, Jelin EB3.
Author information
1
Pediatric Pulmonology, Johns Hopkins University, Baltimore, Maryland.
2
Pediatric Surgery, University of Texas Health Science Center at Houston, Houston, Texas.
3
Pediatric Surgery, Johns Hopkins University, Baltimore, Maryland.
Abstract
INTRODUCTION:
The purpose of this study was to examine the clinical features/outcomes associated with tracheostomy in infants with congenital diaphragmatic hernia (CDH).

METHODS:
The 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.

RESULTS:
The 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.

CONCLUSION:
There 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.

© 2019 Wiley Periodicals, Inc.

KEYWORDS:
congenital diaphragmatic hernia; mechanical ventilators; tracheostomy

PMID: 31502766 DOI: 10.1002/ppul.24516