Tracheostomy in children is associated with neutrophilic airway inflammation

Jason Powell*, Steven Powell, Michael W. Mather, Lauren Beck, Andrew Nelson, Pawel Palmowski, Andrew Porter, Jonathan Coxhead, Ann Hedley, Jonathan Scott, Anthony J. Rostron, Thomas P. Hellyer, Fatima Zaidi, Tracey Davey, James P. Garnett, Rachel Agbeko, Chris Ward, Christopher J Stewart, Clifford C. Taggart, Malcolm BrodlieA. John Simpson

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

1 Citation (Scopus)
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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.
Original languageEnglish
Pages (from-to)1019-1027
Number of pages9
Issue number10
Early online date20 Feb 2023
Publication statusPublished - 1 Oct 2023


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