Bronchopulmonary dysplasia requiring tracheostomy: A review of management and outcomes

Karkoutli, Adam Ahmad; Brumund, Michael R.; Evans, Adele K.

doi:10.1016/j.ijporl.2020.110449

Cited by 7 publications

(5 citation statements)

References 105 publications

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“…Severe BPD (sBPD) is a disease that primarily affects infants born <32 weeks’ gestation, with a reported incidence of 42% among infants 501–750 grams birth weight and 25% among those with 751–1000 grams birth weight [ 18 , 19 ]. Chronic mechanical ventilation with tracheostomy that serves to transition infants and their families from the NICU to the outpatient setting can be a viable management strategy but is associated with significant complications and morbidities including poor wound healing, air leak, stoma problems, accidental decannulation, and mucus plugs [ 20 – 22 ]. As infants grow older there are common reports of tracheal lesions such as fistulas, stenosis, collapse and peristomal granulation [ 23 ].…”

Section: Discussionmentioning

confidence: 99%

Qualitative indications for tracheostomy and chronic mechanical ventilation in patients with severe bronchopulmonary dysplasia

et al. 2021

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Background The decision to pursue chronic mechanical ventilation involves a complex mix of clinical and social considerations. Understanding the medical indications to pursue tracheostomy would reduce the ambiguity for both providers and families and facilitate focus on appropriate clinical goals. Objective To describe potential indications to pursue tracheostomy and chronic mechanical ventilation in infants with severe BPD (sBPD). Study design We surveyed centers participating in the Children’s Hospitals Neonatal Consortium to describe their approach to proceed with tracheostomy in infants with sBPD. We requested a single representative response per institution. Question types were fixed form and free text responses. Results The response rate was high (31/34, 91%). Tracheostomy was strongly considered when: airway malacia was present, PCO 2 ≥ 76–85 mmHg, FiO 2 ≥ 0.60, PEEP ≥ 9–11 cm H 2 O, respiratory rate ≥ 61–70 breaths/min, PMA ≥ 44 weeks, and weight <10th %ile at 44 weeks PMA. Conclusions Understanding the range of indications utilized by high level NICUs around the country to pursue a tracheostomy in an infant with sBPD is one step toward standardizing consensus indications for tracheostomy in the future.

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Section: Discussionmentioning

confidence: 99%

Qualitative indications for tracheostomy and chronic mechanical ventilation in patients with severe bronchopulmonary dysplasia

et al. 2021

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“…Bei schwersten Formen einer bronchopulmonalen Dysplasie (BPD) mit pulmonaler Hypertension ist zur Langzeitbeatmung die Anlage eines Tracheostomas indiziert [72]. Bei mehr als 200 ehemals Früh-und Reifgeborenen, die im 1.…”

Section: Tracheostomaunclassified

Atmung und Schlafregulation beim Neugeborenen

Quante,

Poets,

Hübler

2023

Neonatologie Scan

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“…10,11 These patients require prolonged hospitalization and long-term intensive care given their medical complexity. [12][13][14][15][16] Research on tracheostomy outcomes for children with BPD has yielded varied findings on morbidity and mortality, perhaps due to the influence of comorbidities. [17][18][19][20] The relationship between patient characteristics, rates of tracheostomy, hospital readmissions, and mortality have been described for children with BPD.…”

Section: Introductionmentioning

confidence: 99%

Bronchopulmonary Dysplasia and Ventilation-Associated Outcomes After Pediatric Tracheostomy

Johnson,

Beams,

Nadar

et al. 2024

Preprint

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Objectives: To determine the time to ventilator liberation and decannulation after tracheostomy placement in children with bronchopulmonary dysplasia (BPD) and pulmonary hypertension. Methods: A prospective cohort study included all children (<18 years old) who underwent tracheostomy between 2015 and 2021 with or without a diagnosis of BPD. The primary outcome measures were times to mechanical ventilator liberation, tracheostomy decannulation, or death with tracheostomy in place. Patient demographics, associated comorbidities, and outcomes were compared between groups. Results: A total of 318 children met inclusion with a median (interquartile, IQR) age at tracheostomy of 6.9 (IQR: 4.1 – 49.2) months and 54% (N=170) were male. A diagnosis of BPD was made for 43% (N=136) and this group was younger at tracheostomy placement (5.2 vs. 24.5 months, P<.001) and more often had pulmonary hypertension (65% vs. 24%, P<.001) than children without BPD. Children with BPD spent a median of 2.92 years (IQR: 1.60 – 4.03) on mechanical ventilation compared to 1.84 years (IQR: 0.84 – 3.60) for children without BPD ( P=.003). Unadjusted estimation of time to decannulation was longer for children with BPD (HR=0.92, 95% CI: 0.62 – 1.38). The adjusted survival analysis for time to mortality included pulmonary hypertension as a variable of significance (aHR= 2.5, 95% CI: 1.43 – 4.40). Conclusion: The presence of BPD is associated with an increased duration of mechanical ventilation and time to tracheostomy decannulation. Pulmonary hypertension is associated with an increased mortality risk among this vulnerable population of children.

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Bronchopulmonary dysplasia requiring tracheostomy: A review of management and outcomes

Cited by 7 publications

References 105 publications

Qualitative indications for tracheostomy and chronic mechanical ventilation in patients with severe bronchopulmonary dysplasia

Qualitative indications for tracheostomy and chronic mechanical ventilation in patients with severe bronchopulmonary dysplasia

Atmung und Schlafregulation beim Neugeborenen

Bronchopulmonary Dysplasia and Ventilation-Associated Outcomes After Pediatric Tracheostomy

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