title: Tracheostomy placement in infants with bronchopulmonary dysplasia: safety and outcomes.
abstract: Optimizing the timing and safety for the placement of a tracheostomy in infants with bronchopulmonary dysplasia (BPD) has not been determined. The purpose of the present study was to describe the data from a single institution about the efficacy and safety of tracheostomy placement in infants with BPD needing long-term respiratory support. We established a service line for the comprehensive care of infants with BPD and we collected retrospective clinical data from this service line. We identified patients that had a trachostomy placed using the local Vermont-Oxford database, and obtained clinical data from chart reviews. We identified infants who had a tracheostomy placed for the indication of severe BPD only. Safety and respiratory efficacy was assessed by overall survival to discharge and the change in respiratory supportive care from just before placement to 1-month post-placement. Twenty-two patients (750 ± 236 g, 25.4 ± 2.1 weeks gestation) had a tracheostomy placed on day of life 177 ± 74 which coincided with a post-conceptual age of 51 ± 10 weeks. At placement these infants were on high settings to support their lung disease. The mean airway pressure (MAP) was 14.3 ± 3.3 cmH(2) O, the peak inspiratory pressure was 43.7 ± 8.0 cmH(2) O, and the FiO(2) was 0.51 ± 0.13. The mean respiratory severity score (MAP × FiO(2) ) 1 month after tracheostomy was significantly (P = 0.03) lower than prior to tracheostomy. Survival to hospital discharge was 77%. All patients with tracheostomies that survived were discharged home on mist collar supplemental oxygen. In conclusion, the high survival rate in these patients with severe BPD and the decreased respiratory support after placement of a tracheostomy suggests that high ventilatory pressures should not be a deterrent for placement of a tracheostomy. Future research should be aimed at determining optimal patient selection and timing for tracheostomy placement in infants with severe BPD.
authors.affiliation: Division of Neonatology, Department of Pediatrics, Baylor College of Medicine, Houston, TX 77030. gmandy@bcm.edu
authors.forename: George
authors.initials: G
authors.lastname: Mandy
authors.forename: Manish
authors.initials: M
authors.lastname: Malkar
authors.forename: Stephen E
authors.initials: SE
authors.lastname: Welty
authors.forename: Rachel
authors.initials: R
authors.lastname: Brown
authors.forename: Edward
authors.initials: E
authors.lastname: Shepherd
authors.forename: William
authors.initials: W
authors.lastname: Gardner
authors.forename: Alicia
authors.initials: A
authors.lastname: Moise
authors.forename: Alfred
authors.initials: A
authors.lastname: Gest
mesh_terms: D001997:Bronchopulmonary Dysplasia / Q000401:mortality / Q000601:surgery* / Q000628:therapy; D003131:Combined Modality Therapy; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D007234:Infant, Premature; D008297:Male; D012138:Respiratory Therapy; D012189:Retrospective Studies; D012720:Severity of Illness Index; D014139:Tracheostomy; D016896:Treatment Outcome