RT Journal Article
SR Electronic
T1 Tracheostomy in children is associated with neutrophilic airway inflammation
JF Thorax
JO Thorax
FD BMJ Publishing Group Ltd and British Thoracic Society
SP thorax-2022-219557
DO 10.1136/thorax-2022-219557
A1 Jason Powell
A1 Steven Powell
A1 Michael W Mather
A1 Lauren Beck
A1 Andrew Nelson
A1 Pawel Palmowski
A1 Andrew Porter
A1 Jonathan Coxhead
A1 Ann Hedley
A1 Jonathan Scott
A1 Anthony J Rostron
A1 Thomas P Hellyer
A1 Fatima Zaidi
A1 Tracey Davey
A1 James P Garnett
A1 Rachel Agbeko
A1 Chris Ward
A1 Christopher J Stewart
A1 Clifford C Taggart
A1 Malcolm Brodlie
A1 A John Simpson
YR 2023
UL http://thorax.bmj.com/content/early/2023/02/19/thorax-2022-219557.abstract
AB Background Tracheostomies in children are associated with significant morbidity, poor quality of life, excess healthcare costs and excess mortality. The underlying mechanisms facilitating adverse respiratory outcomes in tracheostomised children are poorly understood. We aimed to characterise airway host defence in tracheostomised children using serial molecular analyses.Methods Tracheal aspirates, tracheal cytology brushings and nasal swabs were prospectively collected from children with a tracheostomy and controls. Transcriptomic, proteomic and metabolomic methods were applied to characterise the impact of tracheostomy on host immune response and the airway microbiome.Results Children followed up serially from the time of tracheostomy up to 3 months postprocedure (n=9) were studied. A further cohort of children with a long-term tracheostomy were also enrolled (n=24). Controls (n=13) comprised children without a tracheostomy undergoing bronchoscopy. Long-term tracheostomy was associated with airway neutrophilic inflammation, superoxide production and evidence of proteolysis when compared with controls. Reduced airway microbial diversity was established pre-tracheostomy and sustained thereafter.Conclusions Long-term childhood tracheostomy is associated with a inflammatory tracheal phenotype characterised by neutrophilic inflammation and the ongoing presence of potential respiratory pathogens. These findings suggest neutrophil recruitment and activation as potential exploratory targets in seeking to prevent recurrent airway complications in this vulnerable group of patients.Data are available upon reasonable request.