(A929) Impact of High Ventilator Settings on Pediatric Tracheostomy Outcomes

Introduction: Severe bronchopulmonary dysplasia (sBPD) is a major complication of prematurity, often necessitating tracheostomy due to complex ventilatory requirements. Despite advances in neonatal care increasing survival rates, standardization in tracheostomy indications and outcome reporting remains limited. This study evaluates clinical outcomes of tracheostomy in sBPD patients stratified by ventilator settings to guide care improvements and identify factors associated with complications and mortality.

Methods: In this retrospective cohort study, infants with sBPD requiring tracheostomy before one year of age at Children’s Hospital Colorado (2013–2023) were categorized into high- and low-risk ventilator groups. High-risk settings included PEEP > 12.0, baseline FiO₂ > 60%, inhaled nitric oxide (iNO) use, or continuous IV sedation. Demographics, clinical characteristics, ventilatory parameters, and perioperative outcomes were analyzed using Wilcoxon Rank Sum and Chi-Square tests.

Results: Among 183 patients, 128 were high-risk and 55 low-risk. No differences were observed in gestational age, birth weight, or socioeconomic status (DCI) between groups. However, high-risk patients were more likely to be Black, with no differences in other races/ethnicities. Preoperatively, high-risk patients had higher rates of pulmonary hypertension, prolonged intubation, and IV sedation. Postoperatively, they required longer NICU and hospital stays and experienced more frequent code blue events. Despite these challenges, there were no significant differences in mortality during initial admission, decannulation rates, or readmissions between groups.

Conclusions: These findings underscore the feasibility of tracheostomy in high-risk sBPD patients when appropriate resources are available. The results emphasize the need for standardized criteria and multidisciplinary care bundles to optimize perioperative and long-term outcomes, particularly for high-risk populations.