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Qualitative indications for tracheostomy and chronic mechanical ventilation in patients with severe bronchopulmonary dysplasia. | LitMetric
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 ≥ 76-85 mmHg, FiO ≥ 0.60, PEEP ≥ 9-11 cm HO, 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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