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Tracheostomy in children is associated with neutrophilic airway inflammation

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...

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Autores principales: Powell, Jason, Powell, Steven, Mather, Michael W, Beck, Lauren, Nelson, Andrew, Palmowski, Pawel, Porter, Andrew, Coxhead, Jonathan, Hedley, Ann, Scott, Jonathan, Rostron, Anthony J, Hellyer, Thomas P, Zaidi, Fatima, Davey, Tracey, Garnett, James P, Agbeko, Rachel, Ward, Chris, Stewart, Christopher J, Taggart, Clifford C, Brodlie, Malcolm, Simpson, A John
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BMJ Publishing Group 2023
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10511973/
https://www.ncbi.nlm.nih.gov/pubmed/36808087
http://dx.doi.org/10.1136/thorax-2022-219557
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author Powell, Jason
Powell, Steven
Mather, Michael W
Beck, Lauren
Nelson, Andrew
Palmowski, Pawel
Porter, Andrew
Coxhead, Jonathan
Hedley, Ann
Scott, Jonathan
Rostron, Anthony J
Hellyer, Thomas P
Zaidi, Fatima
Davey, Tracey
Garnett, James P
Agbeko, Rachel
Ward, Chris
Stewart, Christopher J
Taggart, Clifford C
Brodlie, Malcolm
Simpson, A John
author_facet Powell, Jason
Powell, Steven
Mather, Michael W
Beck, Lauren
Nelson, Andrew
Palmowski, Pawel
Porter, Andrew
Coxhead, Jonathan
Hedley, Ann
Scott, Jonathan
Rostron, Anthony J
Hellyer, Thomas P
Zaidi, Fatima
Davey, Tracey
Garnett, James P
Agbeko, Rachel
Ward, Chris
Stewart, Christopher J
Taggart, Clifford C
Brodlie, Malcolm
Simpson, A John
author_sort Powell, Jason
collection PubMed
description 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.
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spelling pubmed-105119732023-09-22 Tracheostomy in children is associated with neutrophilic airway inflammation Powell, Jason Powell, Steven Mather, Michael W Beck, Lauren Nelson, Andrew Palmowski, Pawel Porter, Andrew Coxhead, Jonathan Hedley, Ann Scott, Jonathan Rostron, Anthony J Hellyer, Thomas P Zaidi, Fatima Davey, Tracey Garnett, James P Agbeko, Rachel Ward, Chris Stewart, Christopher J Taggart, Clifford C Brodlie, Malcolm Simpson, A John Thorax Paediatric Lung Disease 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. BMJ Publishing Group 2023-10 2023-02-20 /pmc/articles/PMC10511973/ /pubmed/36808087 http://dx.doi.org/10.1136/thorax-2022-219557 Text en © Author(s) (or their employer(s)) 2023. Re-use permitted under CC BY. Published by BMJ. https://creativecommons.org/licenses/by/4.0/This is an open access article distributed in accordance with the Creative Commons Attribution 4.0 Unported (CC BY 4.0) license, which permits others to copy, redistribute, remix, transform and build upon this work for any purpose, provided the original work is properly cited, a link to the licence is given, and indication of whether changes were made. See: https://creativecommons.org/licenses/by/4.0/.
spellingShingle Paediatric Lung Disease
Powell, Jason
Powell, Steven
Mather, Michael W
Beck, Lauren
Nelson, Andrew
Palmowski, Pawel
Porter, Andrew
Coxhead, Jonathan
Hedley, Ann
Scott, Jonathan
Rostron, Anthony J
Hellyer, Thomas P
Zaidi, Fatima
Davey, Tracey
Garnett, James P
Agbeko, Rachel
Ward, Chris
Stewart, Christopher J
Taggart, Clifford C
Brodlie, Malcolm
Simpson, A John
Tracheostomy in children is associated with neutrophilic airway inflammation
title Tracheostomy in children is associated with neutrophilic airway inflammation
title_full Tracheostomy in children is associated with neutrophilic airway inflammation
title_fullStr Tracheostomy in children is associated with neutrophilic airway inflammation
title_full_unstemmed Tracheostomy in children is associated with neutrophilic airway inflammation
title_short Tracheostomy in children is associated with neutrophilic airway inflammation
title_sort tracheostomy in children is associated with neutrophilic airway inflammation
topic Paediatric Lung Disease
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10511973/
https://www.ncbi.nlm.nih.gov/pubmed/36808087
http://dx.doi.org/10.1136/thorax-2022-219557
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