Hyperinflation and its association with successful transition to home ventilator devices in infants with chronic respiratory failure and severe bronchopulmonary dysplasia

Abstract

To estimate the association between lung hyperin ation and the time to successful transition to outpatient ventilators in infants with sBPD and chronic respiratory failure. Design/Methods:Infants with sBPD < 32 weeks' gestation who received tracheostomies were identi ed. Hyperin ation was the main exposure. Time from tracheostomy to successful transition to the outpatient device was the main outcome. Kaplan-Meier and multivariable Cox proportional hazards were used to estimate the relationships between hyperin ation and the main outcome. ResultsSixty-two infants were included; 26 (42%) were hyperin ated. Eleven died before transition, and 51 successfully transitioned. Hyperin ation was associated with both mortality (31% vs 8.3%, p = 0.02) and an increased duration (72 vs. 56 days) to successful transition (hazard ratio (HR) = 0.38, 95% CI: 0.19, 0.76, p = 0.006). Growth velocity was similar after tracheostomy placement. ConclusionsIn infants with chronic respiratory failure and sBPD < 32 weeks' gestation, hyperin ation is related to mortality and inpatient morbidities.

Types of home respiratory support in children with bronchopulmonary dysplasia and factors determining its duration: A scoping review

“…21,[23][24][25] One study reported CPAP/Bpap at discharge 15 whereas, in seven studies, infants needed tracheostomy ventilation at discharge. [15][16][17][18][19][20]22 Overall, the highest number of infants were discharged on home oxygen (4376), only one infant in this systematic review was discharged on CPAP and one on BPAP. A total of 416 infants needed tracheostomy ventilation at discharge.…”

“…4/11 studies had home oxygen as the respiratory support at discharge, and the infants were classified as moderate to severe BPD 21,23–25 . One study reported CPAP/Bpap at discharge 15 whereas, in seven studies, infants needed tracheostomy ventilation at discharge 15–20,22 . Overall, the highest number of infants were discharged on home oxygen (4376), only one infant in this systematic review was discharged on CPAP and one on BPAP.…”

“…Our review includes three observational case-control 19,22,24 and eight observational cohort studies. Table 2 summarizes all the significant results.…”

“…Following our inclusion and exclusion criteria, 11 studies were finally included in this review. [15][16][17][18][19][20][21][22][23][24][25] Most of the excluded studies were review articles and not original studies as such. One of the excluded studies related to chronic lung disease in term babies.…”

“…The studies were classified according to the OCEBM(Oxford Center for Evidence-Based Medicine) levels of evidence and the quality was scored using the McGrath quality assessment. 28 There are five Grade 3 [16][17][18]20,21 and six Grade 4 15,19,[22][23][24][25] studies as per OCEBM(Table 3). The differences between studies are the severity of BPD and the degree of respiratory support that is, home oxygen, noninvasive ventilation, and tracheostomy ventilation.…”