TY - JOUR
T1 - Qualitative indications for tracheostomy and chronic mechanical ventilation in patients with severe bronchopulmonary dysplasia
AU - Children’s Hospital Neonatal Consortium severe bronchopulmonary dysplasia subgroup
AU - Yallapragada, Sushmita
AU - Savani, Rashmin C.
AU - Mūnoz-Blanco, Sara
AU - Lagatta, Joanne M.
AU - Truog, William E.
AU - Porta, Nicolas F.M.
AU - Nelin, Leif D.
AU - Zhang, Huayan
AU - Vyas-Read, Shilpa
AU - DiGeronimo, Robert
AU - Natarajan, Girija
AU - Wymore, Erica
AU - Haberman, Beth
AU - Machry, Joana
AU - Potoka, Karin
AU - Murthy, Karna
N1 - Publisher Copyright:
© 2021, The Author(s), under exclusive licence to Springer Nature America, Inc.
PY - 2021/11
Y1 - 2021/11
N2 - 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, PCO2 ≥ 76–85 mmHg, FiO2 ≥ 0.60, PEEP ≥ 9–11 cm H2O, 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.
AB - 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, PCO2 ≥ 76–85 mmHg, FiO2 ≥ 0.60, PEEP ≥ 9–11 cm H2O, 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.
UR - http://www.scopus.com/inward/record.url?scp=85113737966&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=85113737966&partnerID=8YFLogxK
U2 - 10.1038/s41372-021-01165-9
DO - 10.1038/s41372-021-01165-9
M3 - Article
C2 - 34349231
AN - SCOPUS:85113737966
SN - 0743-8346
VL - 41
SP - 2651
EP - 2657
JO - Journal of Perinatology
JF - Journal of Perinatology
IS - 11
ER -