Clinical Factors Influencing Time to Decannulation in Children with Tracheostomy and Ventilator Dependence Secondary to Bronchopulmonary Dysplasia

Objective To determine whether demographic or clinical factors affected the time to tracheostomy decannulation for patients with severe bronchopulmonary dysplasia (BPD). Study design We retrospectively abstracted information from the electronic medical record for 93 patients with BPD or chronic lung disease of prematurity with tracheostomy and ventilator dependence cared for in our Pulmonary Clinic between January 1, 2006, and December 31, 2015. Univariable and multivariable models controlling for sex, race, ethnicity, and gestational age assessed the impact of cohort demographics, comorbid medical conditions, and physician factors on time to decannulation. Results The mean age of the 66 patients who were decannulated was 3.3 ± 1.12 years. Having a chronic neurologic condition was associated with a prolonged time to tracheostomy decannulation (hazard ratio, 0.3; 95% CI, 0.1-0.9), particularly if the patient was not decannulated by 3 years of age. Individuals who had only pulmonary hypertension, required airway reconstruction, or had none of the identified risk factors had similar rates of tracheostomy decannulation. Race, ethnicity, and provider clinical volume were not significantly associated with time to decannulation. Conclusions A chronic neurologic condition was the sole factor significantly associated with time to tracheostomy decannulation in our patients with severe BPD. Further work to understand the driving factors for this association will allow clinicians to provide families with more informed guidance as they navigate the complex process of long-term mechanical ventilation.