title: Retrospective Analysis of an Interdisciplinary Ventilator Care Program Intervention on Survival of Infants with Ventilator-Dependent Bronchopulmonary Dysplasia.
abstract: BackgroundThe clinical needs of infants with severe bronchopulmonary dysplasia (BPD) that remain ventilator-dependent are complex, and management strategies that optimize survival and long-term outcomes controversial. We hypothesized that an interdisciplinary ventilator care program (VCP), committed to the care of this population will improve survival through standardized approaches to cardiopulmonary care and related comorbidities, enhanced communication, and continuity of care.MethodsRetrospective chart reviews were performed on patients at Children's Hospital Colorado's neonatal intensive care unit, who underwent tracheostomy placement between 2000 and 2013. Data were collected for two time periods: 2000 to 2005 and 2006 to 2013, before and after initiation of the VCP. Collected data on infants with ventilator-dependent BPD included: gestational age (GA), age at tracheostomy, respiratory severity score (RSS; mean airway pressure [MAP] × fraction of inspired oxygen [FiO2]), comorbidities, medication use, and the age of death. Tracheostomy patients without severe BPD were excluded.ResultsDespite no difference in GA, birth weight, or cardiorespiratory comorbidities, survival to discharge increased from 50 to 85% after implementation of the VCP (p< 0.05). Between period 1 and 2, there were differences in systemic and inhaled steroid use and mucolytic use.ConclusionThese findings suggest an interdisciplinary approach to the care of infants with ventilator-dependent BPD can improve survival.
authors.affiliation: Pediatric Heart Lung Center, Department of Pediatrics, University of Colorado School of Medicine, Aurora, Colorado.
authors.forename: Jason
authors.initials: J
authors.lastname: Gien
authors.affiliation: Pediatric Heart Lung Center, Department of Pediatrics, University of Colorado School of Medicine, Aurora, Colorado.
authors.forename: John
authors.initials: J
authors.lastname: Kinsella
authors.affiliation: Division of Pulmonary Medicine, Department of Pediatrics, University of Colorado School of Medicine, Aurora, Colorado.
authors.forename: Jodi
authors.initials: J
authors.lastname: Thrasher
authors.affiliation: Pediatric Heart Lung Center, Department of Pediatrics, University of Colorado School of Medicine, Aurora, Colorado.
authors.forename: Alicia
authors.initials: A
authors.lastname: Grenolds
authors.affiliation: Pediatric Heart Lung Center, Department of Pediatrics, University of Colorado School of Medicine, Aurora, Colorado.
authors.forename: Steven H
authors.initials: SH
authors.lastname: Abman
authors.affiliation: Pediatric Heart Lung Center, Department of Pediatrics, University of Colorado School of Medicine, Aurora, Colorado.
authors.forename: Christopher D
authors.initials: CD
authors.lastname: Baker
mesh_terms: D001997:Bronchopulmonary Dysplasia / Q000628:therapy*; D003142:Communication; D003266:Continuity of Patient Care; D005100:Expectorants / Q000627:therapeutic use; D005260:Female; D006801:Humans; D007223:Infant; D007234:Infant, Premature; D065186:Interrupted Time Series Analysis; D008297:Male; D010348:Patient Care Team / Q000458:organization & administration; D012121:Respiration, Artificial; D012189:Retrospective Studies; D013256:Steroids / Q000627:therapeutic use; D015996:Survival Rate; D014139:Tracheostomy; D012122:Ventilators, Mechanical
chemical_list: D005100:Expectorants; D013256:Steroids