Respiratory, growth, and survival outcomes of infants with tracheostomy and ventilator dependence.
Respiratory, growth, and survival outcomes of infants with tracheostomy and ventilator dependence.
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DOI：
10.1038/s41390-020-01183-x
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发表时间：
2021-08
影响因子：
3.6
通讯作者：
Manimtim W
中科院分区：
文献类型：
--
作者：
Akangire G;Taylor JB;McAnany S;Noel-MacDonnell J;Lachica C;Sampath V;Manimtim W
文献中尚未充分描述婴儿气管切开术的结果。我们的目标是描述气管切开术婴儿的呼吸、生长和生存结果。对 2005 年至 2015 年间出生的 204 名婴儿进行了一项回顾性研究，这些婴儿在 <1 岁时接受了气管切开术，并在婴儿气管切开术和家庭呼吸机诊所随访至 4 岁。气管切开术的平均年龄为 4.5 个月，中位年龄为 3 个月。拔管的中位年龄为 32 个月。从气管切开术放置到完全停止机械通气的时间为15.4个月，从气管切开术到拔管的时间为33.8个月。死亡率为 21%，中位死亡年龄为 18 个月。与足月儿相比，患有后天性气道和肺部疾病（BPD）且妊娠<28周出生的早产儿的存活率显着更高。从出院时（平均实足年龄 6.5 个月）到第一年，体重和身长体重 Z 评分有所改善，并在 3 年内保持一致。与足月儿相比，早产儿停止机械通气和拔管的比率更高。这些婴儿表现出一致的生长和相当的存活率。在多学科临床模型中进行气管切开术和呼吸机依赖的婴儿可能会改善生存、生长并缩短拔管时间。与具有各种气管切开指征的足月儿相比，患有获得性气道和肺部疾病（BPD）且接受气管切开术的早产儿的存活率更高。婴儿气管切开年龄为 4.5 个月，拔管年龄为 37 个月。从气管切开到完全停止机械通气的时间为15.4个月。将这些数据添加到稀疏的文献中对于为家庭提供咨询和对医务人员进行教育至关重要。
Outcome of infants with tracheostomy have not been well described in the literature. Our objective was to describe the respiratory, growth, and survival outcomes of infants with tracheostomy. A retrospective study was conducted on 204 infants born between 2005 and 2015 with tracheostomy at <1 year of age and follow-up in the Infant Tracheostomy and Home Ventilator Clinic up to 4 years of age. The mean age at tracheostomy was 4.5 months with median age of 3 months. Median age of decannulation was 32 months. The time from tracheostomy placement to complete discontinuation of mechanical ventilation was 15.4 months and from tracheostomy to decannulation was 33.8 months. Mortality rate was 21% and median age of death was 18 months. Preterm infants with acquired airway and lung disease (BPD) and born at <28 weeks’ gestation had a significantly higher survival rate compared to term infants. The z-scores for weight and weight for length improved from the time of discharge (mean chronological age 6.5 months) to first year and remained consistent through 3 years. Premature infants had a higher rate of discontinuation of mechanical ventilation and decannulation compared to term infants. These infants showed consistent growth and comparable survival rate. Infants with tracheostomy and ventilator dependence followed in a multidisciplinary clinic model may have improved survival, growth, and earlier time to decannulation. Preterm infants with acquired airway and lung disease (BPD) with tracheostomy had a higher survival rate compared to term infants with various tracheostomy indications. The age at tracheostomy in infants was 4.5 months and of decannulation was 37 months. Time from tracheostomy to complete discontinuation of mechanical ventilation was 15.4 months. Addition of this data to the sparse literature will be crucial in counseling the families and education of medical staff.
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