Tracheostomy placement in infants with bronchopulmonary dysplasia: Safety and outcomes
Tracheostomy placement in infants with bronchopulmonary dysplasia: Safety and outcomes
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DOI：
10.1002/ppul.22572
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发表时间：
2013-03-01
影响因子：
3.1
通讯作者：
Gest, Alfred
中科院分区：
文献类型：
--
作者：
Mandy, George;Malkar, Manish;Gest, Alfred
对患有支气管肺发育不良(BPD)的婴儿进行气管切开术的最佳时机和安全性尚未确定。本研究的目的是描述来自单一机构的关于BPD婴儿需要长期呼吸支持的气管切开术的有效性和安全性的数据。我们建立了一条综合护理BPD婴儿的服务线路，并从该服务线路收集了回顾性的临床数据。我们利用当地的佛蒙特州-牛津数据库确定了进行气管造口术的患者，并从图表回顾中获得了临床数据。我们确定了仅为重度BPD指征而行气管切开术的婴儿。安全性和呼吸疗效通过从放置前到放置后1个月的总体存活到出院以及呼吸支持护理的变化来评估。22例患者(孕龄750+/-236g，25.4+/-2.1周)在出生当天177+/-74进行了气管切开术，这与妊娠后51+/-10周的年龄一致。在安置时，这些婴儿处于高位以支持他们的肺部疾病。平均气道压(MAP)为14.3±3.3cmH2O，吸气峰压为43.7+/-8.0cmH2O，FiO2为0.51+/-0.13。气管切开后1个月的平均呼吸严重程度评分(MAPxFiO2)明显低于气管切开前(P=0.03)。出院前存活率为77%。所有存活的气管造口术患者都在雾领补充氧气的情况下出院。总而言之，这些严重BPD患者的高存活率和气管切开术后呼吸支持的减少表明，高通气压不应该成为放置气管切开术的障碍。未来的研究应该旨在确定对患有严重BPD的婴儿进行气管切开术的最佳患者选择和时机。儿科肺单醇。2013年；48：245249。(C)2012年威利期刊公司。
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 +/- 236g, 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 +/- 3.3cmH2O, the peak inspiratory pressure was 43.7 +/- 8.0cmH2O, and the FiO2 was 0.51 +/- 0.13. The mean respiratory severity score (MAPxFiO2) 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. Pediatr Pulmonol. 2013; 48:245249. (c) 2012 Wiley Periodicals, Inc.