Work

Tracheostomy Tube Change Versus PEEP Titration on Tracheostomy‐Dependent Infants With Airway Malacia and Ventilator Instability

Year: 2025

Type: article

Abstract: Objective To investigate the impact of positive end‐expiratory pressure (PEEP) titrations or tracheostomy size change (trach change) on ventilation stability in infants with tracheobronchomalacia. Study Design A retrospective chart review. Setting Tertiary care children's hospital from 2015 to 2023. Methods A retrospective chart review on ventilator and tracheostomy‐dependent patients <1 year of age. Demographics, bronchoscopic findings, and ventilator outcomes within 14 days were recorded. Analysis was performed with chi‐square, Fisher's exact, binomial regression analysis, and two‐tailed t tests. Results Of 71 patients (66% male, median 6.1 months old [interquartile range, IQR, 4.6‐7.3]) who underwent 74 initial bronchoscopies, the PEEP titration cohort (n = 37) experienced an improvement (narrower) in 24‐hour mean ventilatory ranges (peak inspiratory pressure [PIP] 5.6 pre vs 2.9 post, P = .01; fraction of inspired oxygen [FiO2] range 5% vs 3%, P = .04), whereas the trach change cohort did not (PEEP 5.9 vs 5.6, P = .8; FiO2 10% vs 5%, P = .07). In patients with airway malacia, the PEEP titration cohort had improved PIP ranges postintervention (5.5 vs 3.0, P = .02), whereas the trach change cohort did not (4.4 vs 6.6, P = .13). In patients without airway malacia, trach change correlated with improved PIP (8.4 vs 3.8, P = .04). Repeat bronchoscopy after initial intervention was significantly more common after trach change compared to PEEP titration (22% vs 3%, P = .01). Conclusion PEEP titration was associated with improved PIP and FiO2 ventilatory outcomes with a lower rate of repeat bronchoscopy compared to trach change, suggesting trach change alone may have little impact with greater subsequent interventional needs compared to PEEP titration.

Source: Otolaryngology

DOI: 10.1002/ohn.1278

Authors: Harrison M. Thompson, Mikayla Hubbard, Johnny Krasinkiewicz, Sarah E. Bauer, Diane W. Chen

Institutions: Indiana University Indianapolis, Indiana University – Purdue University Indianapolis, Indiana University School of Medicine

Language: English

Topic: Tracheal and airway disorders

Subfield: Pulmonary and Respiratory Medicine

Field: Medicine

Domain: Health Sciences

SDG: Good health and well-being

Open Access status: hybrid

Estimated APC paid: $3,600