3-Year Outcomes
At 36 months post-tracheostomy placement, 44 children (26.8% of all
children; 33.1% of alive children) were still using respiratory support
and 100 children (61.0% of all children; 75.2% of alive children) were
still cannulated with their tracheostomy (Figure 1b ,Table 3 ). Nearly one-fifth (18.9%) of children died within 3
years post-tracheostomy. Six children were lost to follow up by 3 years
post-tracheostomy; these children were lost to follow up at median 8.9
months post-tracheostomy (IQR: 7.6-11.3 months).
In unadjusted analysis, fewer children with P. aeruginosaidentification were decannulated at 3 years post-tracheostomy as
compared with children without P. aeruginosa (18.2% vs. 35.0%,
p=0.07, Table 3 ) though this difference did not reach
statistical significance. No differences in respiratory support,
decannulation, or mortality outcomes were identified for children with
any pathogen identification vs. no pathogen identification or for
children with chronic P. aeruginosa identification vs. no chronic
identification.
In adjusted analysis, having any P. aeruginosa identification was
associated with lower probability of decannulation by 3 years
post-tracheostomy (adjusted risk ratio [aRR] 0.48, 95% confidence
interval [95% CI] 0.23-0.98, Figure 2 ). Furthermore, when
analyzing count of P. aeruginosa isolations during the timeframe,
each identification of P. aeruginosa was associated with a 35%
lower probability of achieving decannulation by 3 years
post-tracheostomy (aRR 0.65, 95% CI 0.44-0.98). P. aeruginosaidentification was not associated with ongoing use of respiratory
support or mortality at 3 years post-tracheostomy on adjusted analysis.
Any pathogen identification was not associated with any of the measured
3-year outcomes.
In further examination of covariates, increasing number of CCCs per
child was found to be significantly associated with the primary outcome
of ongoing use of respiratory support at 3 years post-tracheostomy for
all models regardless of the predictor group (Appendix Table ).
Non-White, non-Black race (classified as “Other” race) was identified
to be a significant covariate in the association of culture predictors
with mortality by 3 years.