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Tracheostomy placement in infants with bronchopulmonary dysplasia: safety and outcomes
George Mandy1, Manish Malkar, Stephen E Welty
1Division of Neonatology, Department of Pediatrics, Baylor College of Medicine, Houston, TX 77030. gmandy@bcm.edu
Insights
Tracheostomy placement in infants with severe bronchopulmonary dysplasia (BPD) shows improved respiratory support and high survival rates. High ventilatory pressures should not deter this intervention for infants needing long-term respiratory support.
Area of Science:
- Neonatology
- Pediatric Pulmonology
- Surgical Innovation
Background:
- Optimizing tracheostomy timing and safety in infants with bronchopulmonary dysplasia (BPD) remains an area needing further investigation.
- Bronchopulmonary dysplasia is a chronic lung disease in infants requiring long-term respiratory support.
- Tracheostomy is a potential intervention for infants with severe BPD and prolonged ventilation needs.
Purpose of the Study:
- To evaluate the efficacy and safety of tracheostomy placement in infants with severe BPD requiring long-term respiratory support.
- To describe institutional data on tracheostomy outcomes in this specific patient population.
- To assess the impact of tracheostomy on respiratory support needs and survival.
Main Methods:
- Retrospective chart review of infants with BPD who underwent tracheostomy placement.
- Data collected from a single institution's comprehensive care service line for BPD.
- Safety and efficacy assessed by survival to discharge and changes in respiratory support parameters (MAP, PIP, FiO2) before and after tracheostomy.
Main Results:
- Twenty-two infants with severe BPD underwent tracheostomy at a median post-conceptual age of 51 weeks.
- Respiratory support significantly decreased one month post-tracheostomy, indicated by a lower mean respiratory severity score (MAP × FiO2).
- Overall survival to hospital discharge was 77%, with survivors discharged on supplemental oxygen via mist collar.
Conclusions:
- Tracheostomy placement in infants with severe BPD is associated with high survival rates and reduced need for respiratory support.
- High ventilatory pressures should not be a contraindication for tracheostomy in this population.
- Further research is needed to determine optimal patient selection and timing for tracheostomy in severe BPD.
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.
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