title: Outcomes of children with severe bronchopulmonary dysplasia who were ventilator dependent at home.
abstract: OBJECTIVE
  To describe the incidence and outcomes of children with chronic respiratory failure secondary to severe bronchopulmonary dysplasia (BPD) on chronic positive pressure ventilation (PPV) via tracheostomy at home.
  
  
  METHODS
  We retrospectively reviewed medical charts of patients with severe BPD who were PPV dependent at home and who were enrolled in a university-affiliated home ventilator program between 1984 and 2010. We excluded patients with other comorbidities that could contribute to the development of chronic respiratory failure. We reported the incidence of these children in Indiana and cumulative incidences of survival, liberation from PPV, and decannulation.
  
  
  RESULTS
  Over 27 years, 628 children were cared for in our home ventilator program. Of these, 102 patients met inclusion criteria: 83 (81.4%) were alive and 19 (18.6%) were deceased. Sixty-nine patients (67.6%) were liberated from PPV, and 97.1% of them were weaned before their fifth birthday, with a median age at liberation of 24 months (interquartile range, 19-33). Similarly, 60 patients (58.8%) were decannulated, of which 96.7% completed this process before their sixth birthday, with a median age at decannulation of 37.5 months (interquartile range, 31.5-45). The incidence of children with chronic respiratory failure secondary to BPD who were PPV-dependent at home in Indiana was 1.23 per 100 000 live births in 1984 and increased to 4.77 per 100 000 live births in 2010.
  
  
  CONCLUSIONS
  Although extreme prematurity associated with severe BPD necessitating PPV at home carries significant risks of morbidity and mortality, successful liberation from mechanical ventilation and decannulation are likely to occur.
authors.affiliation: Section of Pediatric Pulmonology, Indiana University School of Medicine, Indianapolis, IN, USA. aicriste@iu.edu
authors.forename: A Ioana
authors.initials: AI
authors.lastname: Cristea
authors.forename: Aaron E
authors.initials: AE
authors.lastname: Carroll
authors.forename: Stephanie D
authors.initials: SD
authors.lastname: Davis
authors.forename: Nancy L
authors.initials: NL
authors.lastname: Swigonski
authors.forename: Veda L
authors.initials: VL
authors.lastname: Ackerman
mesh_terms: D001997:Bronchopulmonary Dysplasia / Q000175:diagnosis / Q000401:mortality / Q000628:therapy*; D002675:Child, Preschool; D003430:Cross-Sectional Studies; D005260:Female; D018575:Home Care Services, Hospital-Based; D006801:Humans; D007196:Indiana; D007223:Infant; D052577:Infant, Extremely Low Birth Weight; D007231:Infant, Newborn; D008137:Longitudinal Studies; D008297:Male; D011175:Positive-Pressure Respiration; D012131:Respiratory Insufficiency / Q000175:diagnosis / Q000401:mortality / Q000628:therapy*; D015996:Survival Rate; D014139:Tracheostomy; D015300:Ventilator Weaning
keywords: bronchopulmonary dysplasia; home; outcome; positive pressure ventilation; tracheostomy
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