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

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....

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Autores principales: Yallapragada, Sushmita, Savani, Rashmin C., Mūnoz-Blanco, Sara, Lagatta, Joanne M., Truog, William E., Porta, Nicolas F. M., Nelin, Leif D., Zhang, Huayan, Vyas-Read, Shilpa, DiGeronimo, Robert, Natarajan, Girija, Wymore, Erica, Haberman, Beth, Machry, Joana, Potoka, Karin, Murthy, Karna
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Nature Publishing Group US 2021
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8331995/
https://www.ncbi.nlm.nih.gov/pubmed/34349231
http://dx.doi.org/10.1038/s41372-021-01165-9
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author Yallapragada, Sushmita
Savani, Rashmin C.
Mūnoz-Blanco, Sara
Lagatta, Joanne M.
Truog, William E.
Porta, Nicolas F. M.
Nelin, Leif D.
Zhang, Huayan
Vyas-Read, Shilpa
DiGeronimo, Robert
Natarajan, Girija
Wymore, Erica
Haberman, Beth
Machry, Joana
Potoka, Karin
Murthy, Karna
author_facet Yallapragada, Sushmita
Savani, Rashmin C.
Mūnoz-Blanco, Sara
Lagatta, Joanne M.
Truog, William E.
Porta, Nicolas F. M.
Nelin, Leif D.
Zhang, Huayan
Vyas-Read, Shilpa
DiGeronimo, Robert
Natarajan, Girija
Wymore, Erica
Haberman, Beth
Machry, Joana
Potoka, Karin
Murthy, Karna
author_sort Yallapragada, Sushmita
collection PubMed
description 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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spelling pubmed-83319952021-08-04 Qualitative indications for tracheostomy and chronic mechanical ventilation in patients with severe bronchopulmonary dysplasia Yallapragada, Sushmita Savani, Rashmin C. Mūnoz-Blanco, Sara Lagatta, Joanne M. Truog, William E. Porta, Nicolas F. M. Nelin, Leif D. Zhang, Huayan Vyas-Read, Shilpa DiGeronimo, Robert Natarajan, Girija Wymore, Erica Haberman, Beth Machry, Joana Potoka, Karin Murthy, Karna J Perinatol Article 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. Nature Publishing Group US 2021-08-04 2021 /pmc/articles/PMC8331995/ /pubmed/34349231 http://dx.doi.org/10.1038/s41372-021-01165-9 Text en © The Author(s), under exclusive licence to Springer Nature America, Inc. 2021 This article is made available via the PMC Open Access Subset for unrestricted research re-use and secondary analysis in any form or by any means with acknowledgement of the original source. These permissions are granted for the duration of the World Health Organization (WHO) declaration of COVID-19 as a global pandemic.
spellingShingle Article
Yallapragada, Sushmita
Savani, Rashmin C.
Mūnoz-Blanco, Sara
Lagatta, Joanne M.
Truog, William E.
Porta, Nicolas F. M.
Nelin, Leif D.
Zhang, Huayan
Vyas-Read, Shilpa
DiGeronimo, Robert
Natarajan, Girija
Wymore, Erica
Haberman, Beth
Machry, Joana
Potoka, Karin
Murthy, Karna
Qualitative indications for tracheostomy and chronic mechanical ventilation in patients with severe bronchopulmonary dysplasia
title Qualitative indications for tracheostomy and chronic mechanical ventilation in patients with severe bronchopulmonary dysplasia
title_full Qualitative indications for tracheostomy and chronic mechanical ventilation in patients with severe bronchopulmonary dysplasia
title_fullStr Qualitative indications for tracheostomy and chronic mechanical ventilation in patients with severe bronchopulmonary dysplasia
title_full_unstemmed Qualitative indications for tracheostomy and chronic mechanical ventilation in patients with severe bronchopulmonary dysplasia
title_short Qualitative indications for tracheostomy and chronic mechanical ventilation in patients with severe bronchopulmonary dysplasia
title_sort qualitative indications for tracheostomy and chronic mechanical ventilation in patients with severe bronchopulmonary dysplasia
topic Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8331995/
https://www.ncbi.nlm.nih.gov/pubmed/34349231
http://dx.doi.org/10.1038/s41372-021-01165-9
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