Relative timelines for transition from a hospital ventilator to invasive home respiratory support after tracheostomy in infants with chronic respiratory failure

Introduction Infants undergoing tracheostomy placement who require long-term mechanical ventilation are a growing population, and few studies have investigated the methods by which infants are transitioned from a hospital ventilator to modes of home respiratory support after tracheostomy placement. It is difficult to estimate the timeline for this transition, leaving providers without sufficient evidence to counsel caregivers of these infants before and during this process. Methods This retrospective cohort study examined data from infants ( n = 76) with and without bronchopulmonary dysplasia (BPD) who underwent tracheostomy placement and describes the timeline of this transition from tracheostomy placement to discharge and other relevant characteristics affecting this transition. Results Though the infants without BPD were expected to vary greatly from those with BPD due to different and more heterogeneous physiology, the infants without BPD had similar in-hospital mortality and corrected age at tracheostomy placement, discharge, and other relevant timepoints in their transition to a mode of home respiratory support compared to those with BPD. Placement on a pressure-controlled ventilator mode at the start of transition showed a reduced time from stability on a home ventilator to discharge compared to those placed on volume-controlled ventilation in this cohort. Infants discharged on a heated-humidified tracheostomy collar had a similar time from stability on their mode of home respiratory support to hospital discharge compared to infants discharged on a portable home ventilator. Conclusion Infants with and without BPD had similar transition timelines after tracheostomy placement. The mode of home respiratory support significantly affected this timeline in this small cohort, providing important hypothesis-generating data to inform further research.