{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,10,20]],"date-time":"2025-10-20T10:40:37Z","timestamp":1760956837120,"version":"build-2065373602"},"reference-count":18,"publisher":"Wiley","issue":"3","license":[{"start":{"date-parts":[[2025,4,29]],"date-time":"2025-04-29T00:00:00Z","timestamp":1745884800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"}],"content-domain":{"domain":["aao-hnsfjournals.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Otolaryngol.--head neck surg."],"published-print":{"date-parts":[[2025,9]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Objective<\/jats:title><jats:p>To investigate the impact of positive end\u2010expiratory pressure (PEEP) titrations or tracheostomy size change (trach change) on ventilation stability in infants with tracheobronchomalacia.<\/jats:p><\/jats:sec><jats:sec><jats:title>Study Design<\/jats:title><jats:p>A retrospective chart review.<\/jats:p><\/jats:sec><jats:sec><jats:title>Setting<\/jats:title><jats:p>Tertiary care children's hospital from 2015 to 2023.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>A retrospective chart review on ventilator and tracheostomy\u2010dependent patients &lt;1 year of age. Demographics, bronchoscopic findings, and ventilator outcomes within 14 days were recorded. Analysis was performed with chi\u2010square, Fisher's exact, binomial regression analysis, and two\u2010tailed <jats:italic>t<\/jats:italic> tests.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Of 71 patients (66% male, median 6.1 months old [interquartile range, IQR, 4.6\u20107.3]) who underwent 74 initial bronchoscopies, the PEEP titration cohort (n\u2009=\u200937) experienced an improvement (narrower) in 24\u2010hour mean ventilatory ranges (peak inspiratory pressure [PIP] 5.6 pre vs 2.9 post, <jats:italic>P<\/jats:italic>\u2009=\u2009.01; fraction of inspired oxygen [FiO<jats:sub>2<\/jats:sub>] range 5% vs 3%, <jats:italic>P<\/jats:italic>\u2009=\u2009.04), whereas the trach change cohort did not (PEEP 5.9 vs 5.6, <jats:italic>P<\/jats:italic>\u2009=\u2009.8; FiO<jats:sub>2<\/jats:sub> 10% vs 5%, <jats:italic>P<\/jats:italic>\u2009=\u2009.07). In patients with airway malacia, the PEEP titration cohort had improved PIP ranges postintervention (5.5 vs 3.0, <jats:italic>P<\/jats:italic>\u2009=\u2009.02), whereas the trach change cohort did not (4.4 vs 6.6, <jats:italic>P<\/jats:italic>\u2009=\u2009.13). In patients without airway malacia, trach change correlated with improved PIP (8.4 vs 3.8, <jats:italic>P<\/jats:italic>\u2009=\u2009.04). Repeat bronchoscopy after initial intervention was significantly more common after trach change compared to PEEP titration (22% vs 3%, <jats:italic>P<\/jats:italic>\u2009=\u2009.01).<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>PEEP titration was associated with improved PIP and FiO<jats:sub>2<\/jats:sub> ventilatory outcomes with a lower rate of repeat bronchoscopy compared to trach change, suggesting trach change alone may have little impact with greater subsequent interventional needs compared to PEEP titration.<\/jats:p><\/jats:sec>","DOI":"10.1002\/ohn.1278","type":"journal-article","created":{"date-parts":[[2025,4,29]],"date-time":"2025-04-29T06:24:21Z","timestamp":1745907861000},"page":"724-730","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Tracheostomy Tube Change Versus PEEP Titration on Tracheostomy\u2010Dependent Infants With Airway Malacia and Ventilator Instability"],"prefix":"10.1002","volume":"173","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-7030-6388","authenticated-orcid":false,"given":"Harrison M.","family":"Thompson","sequence":"first","affiliation":[{"name":"Department of Otolaryngology\u2013Head and Neck Surgery Indiana University Indianapolis Indiana USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Mikayla","family":"Hubbard","sequence":"additional","affiliation":[{"name":"Department of Otolaryngology\u2013Head and Neck Surgery Indiana University Indianapolis Indiana USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Johnny","family":"Krasinkiewicz","sequence":"additional","affiliation":[{"name":"Department of Pediatric Pulmonology, Allergy, and Sleep Medicine Indiana University Indianapolis Indiana USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Sarah E.","family":"Bauer","sequence":"additional","affiliation":[{"name":"Department of Pediatric Pulmonology, Allergy, and Sleep Medicine Indiana University Indianapolis Indiana USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Diane W.","family":"Chen","sequence":"additional","affiliation":[{"name":"Department of Otolaryngology\u2013Head and Neck Surgery Indiana University Indianapolis Indiana USA"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2025,4,29]]},"reference":[{"key":"e_1_2_8_2_1","doi-asserted-by":"publisher","DOI":"10.1378\/chest.128.5.3391"},{"key":"e_1_2_8_3_1","doi-asserted-by":"publisher","DOI":"10.1513\/AnnalsATS.201702-178OC"},{"key":"e_1_2_8_4_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.cppeds.2018.03.002"},{"volume-title":"StatPearls","year":"2024","author":"Yang D","key":"e_1_2_8_5_1"},{"key":"e_1_2_8_6_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.clp.2015.08.011"},{"key":"e_1_2_8_7_1","doi-asserted-by":"publisher","DOI":"10.1183\/13993003.00382-2019"},{"key":"e_1_2_8_8_1","unstructured":"IBM Corp. 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