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Long-term ventilation for children with chronic lung disease of infancy

Christopher D Baker1

  • 1Section of Pulmonary Medicine and Pediatric Heart Lung Center, Department of Pediatrics, University of Colorado, School of Medicine, Aurora, Colorado, USA.

Current Opinion in Pediatrics
|May 16, 2019
PubMed

Insights

Tracheostomy placement for chronic ventilation may benefit extremely preterm infants with severe bronchopulmonary dysplasia (BPD), aiding growth and development. However, this intervention requires careful consideration due to associated risks and complex care needs.

Area of Science:

  • Neonatal Medicine
  • Pediatric Pulmonology
  • Critical Care

Background:

  • Modern medical advances improve survival rates for extremely preterm infants.
  • Severe bronchopulmonary dysplasia (BPD) can prevent infants from weaning off respiratory support.
  • The optimal candidates for tracheostomy and chronic ventilation remain unclear.

Purpose of the Study:

  • To review the current evidence on tracheostomy placement for infants with severe BPD.
  • To discuss the timing of tracheotomy, ventilation strategies, and multidisciplinary care.
  • To explore considerations for weaning mechanical ventilation and decannulation.

Main Methods:

  • Review of existing literature and evidence regarding chronic ventilation in preterm infants with BPD.
  • Analysis of benefits, risks, and care coordination challenges.
  • Discussion of clinical decision-making for tracheostomy and ventilation management.

Main Results:

  • Evidence suggests chronic ventilation via tracheostomy can support growth and development in severely affected preterm infants.
  • Care coordination and resource utilization are significant challenges.
  • Lack of randomized controlled trials necessitates careful clinical judgment.

Conclusions:

  • Chronic invasive ventilation may improve neurodevelopmental progress and long-term outcomes for preterm infants with respiratory insufficiency.
  • Further research is needed to establish optimal practices and timing for tracheostomy and decannulation.
  • Multidisciplinary care is essential for managing these complex cases.
Abstract

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