Dataset Information

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

ABSTRACT:

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.

SUBMITTER: Yallapragada S

PROVIDER: S-EPMC8331995 | biostudies-literature | 2021 Nov

REPOSITORIES: biostudies-literature

ACCESS DATA

Publications

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

Yallapragada Sushmita S Savani Rashmin C RC Mūnoz-Blanco Sara S Lagatta Joanne M JM Truog William E WE Porta Nicolas F M NFM Nelin Leif D LD Zhang Huayan H Vyas-Read Shilpa S DiGeronimo Robert R Natarajan Girija G Wymore Erica E Haberman Beth B Machry Joana J Potoka Karin K Murthy Karna K

Journal of perinatology : official journal of the California Perinatal Association 20210804 11

<h4>Background</h4>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.<h4>Objective</h4>To describe potential indications to pursue tracheostomy and chronic mechanical ventilation in infants with severe BPD (sBPD).<h4>Study design</h4>We surveyed centers participa ...[more]

PMID: 34349231

Similar Datasets

Project description:BACKGROUND:The relation between mechanical ventilation (MV) and bronchopulmonary dysplasia (BPD) - a common disease in extremely premature newborn (PTNB) - is well stabilished, but is unknown, however, how much time under MV influences the severity of the disease. AIM:To define the duration under MV with greater chance to develop moderate to severe BPD in extremely PTNB and to compare clinical outcomes before and during hospitalization among patients with mild and moderate to severe BPD. METHODS:Fifty-three PTNB were separated into mild and moderate to severe BPD groups and their data were analyzed. Time under MV with a greater chance of developing moderate to severe BPD was estimated by the ROC curve. Perinatal and hospitalization outcomes were compared between groups. A logistic regression was performed to verify the influence of variables associated to moderate to severe BPD development, such as pulmonary hypertension (PH), gender, gestational age (GA) and weight at birth, as well the time under MV found with ROC curve. The result of ROC curve was validated using an independent sample (n =?16) by Chi-square test. RESULTS:Time under MV related to a greater chance of developing moderate to severe BPD was 36?days. Moderate to severe BPD group had more males (14 vs 5, p =?0,047), longer time under MV (43 vs 19?days, p <?0,001), more individuals with PH (12 vs 3, p =?0,016), worse retinopathy of prematurity (grade 3, 2 vs 11, p =?0,003), longer hospital length of stay (109 vs 81,5?days, p <?0,001), greater PMA (41 vs 38?weeks, p <?0,001) and weight (2620 vs 2031?g, p <?0,001) at discharge and the mild BPD group had more CPAP use prior to MV (12 vs 7, p =?0,043). Among all variables included in logistic regression, only PH and MV?<?36?days were significant in the model, explaining 72% of variation in moderate to severe BPD development. In the validation sample, prevalence of preterm infants who needed MV for more than 36?days in the moderate to severe BPD group was 100% (n =?6) and 0% in mild BPD group (p =?0,0001). CONCLUSION:Time under MV related to moderate to severe BPD development is 36?days, and worst outcomes are related to disease severity. PH and time under MV for more than 36?days are related to development of moderate to severe BPD.

Project description:BackgroundAn increased risk for bronchopulmonary dysplasia (BPD) exists when moderate-to-large patent ductus arteriosus shunts (hsPDA) persist beyond 14 days.GoalTo examine the interaction between prolonged exposures to tracheal ventilation (≥10 days) and hsPDA on the incidence of BPD in infants <28 weeks gestation.Study designPredefined definitions of prolonged ventilation (≥10 days), hsPDA (≥14 days), and BPD (room air challenge test at 36 weeks) were used to analyze deidentified data from the multicenter TRIOCAPI RCT in a secondary analysis of the trial.ResultsAmong 307 infants who survived >14 days, 41 died before 36 weeks. Among survivors, 93/266 had BPD. The association between BPD and hsPDA depended on the length of intubation. In multivariable analyses, prolonged hsPDA shunts were associated with increased BPD (odds ratio (OR) (95% confidence interval (CI)) = 3.00 (1.58-5.71)) when infants required intubation for ≥10 days. In contrast, there was no significant association between hsPDA exposure and BPD when infants were intubated <10 days (OR (95% CI) = 1.49 (0.98-2.26)). A similar relationship between prolonged hsPDA and length of intubation was found for BPD/death (n = 307): infants intubated ≥10 days: OR (95% CI) = 2.41 (1.47-3.95)); infants intubated <10 days: OR (95% CI) = 1.37 (0.86-2.19)).ConclusionsModerate-to-large PDAs were associated with increased risks of BPD and BPD/death-but only when infants required intubation ≥10 days.ImpactInfants with a moderate-to-large hsPDA that persist beyond 14 days are only at risk for developing BPD if they also receive prolonged tracheal ventilation for ≥10 days. Infants who receive less ventilatory support (intubation for <10 days) have the same incidence of BPD whether the ductus closes shortly after birth or whether it persists as a moderate-to-large shunt for several weeks. Early PDA closure may be unnecessary in infants who require short durations of intubation since the PDA does not seem to alter the incidence of BPD in infants who require intubation for <10 days.

Dataset Information

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

Background

Objective

Study design

Results

Conclusions

Publications

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

Similar Datasets

OmicsDI is part of the ELIXIR infrastructure

Tweets