Outcomes of Children With Severe Bronchopulmonary Dysplasia Who Were Ventilator Dependent at Home
Outcomes of Children With Severe Bronchopulmonary Dysplasia Who Were Ventilator Dependent at Home
复制标题
DOI：
10.1542/peds.2012-2990
复制
发表时间：
2013-09-01
期刊：
影响因子：
8
通讯作者：
Ackerman, Veda L.
中科院分区：
文献类型：
--
作者：
Cristea, A. Ioana;Carroll, Aaron E.;Ackerman, Veda L.
目的：描述慢性呼吸衰竭继发于严重支气管肺发育不良（BPD）的儿童通过气管造口术在家中接受慢性正压通气（PPV）的发病率和结局：我们回顾性分析了1984年至2010年期间在家中依赖PPV并参加大学附属家庭呼吸机计划的严重BPD患者的病历。我们排除了可能导致慢性呼吸衰竭的其他合并症患者。我们报告了这些儿童在印第安纳州的发病率和累积的生存率，解放PPV，拔管。结果：超过27年，628名儿童在我们的家庭呼吸机计划照顾。其中，102例患者符合入选标准：83例（81.4%）存活，19例（18.6%）死亡。69例患者（67.6%）从PPV中解脱出来，其中97.1%在5岁生日前断奶，解脱时的中位年龄为24个月（四分位距，19 - 33）。同样，60例患者（58.8%）拔管，其中96.7%在6岁之前完成了拔管过程，拔管时的中位年龄为37.5个月（四分位距，31.5 - 45）。1984年，印第安纳州在家中依赖PPV的BPD继发慢性呼吸衰竭儿童的发病率为1.23/10万活产，2010年增至4.77/10万活产。结论：尽管与严重BPD相关的极端早产需要在家进行PPV，但其发病率和死亡率风险很大，可能会成功地从机械通气和拔管中解脱出来。
OBJECTIVE: To describe the incidence and outcomes of children with chronic respiratory failure secondary to severe bronchopulmonary dysplasia (BPD) on chronic positive pressure ventilation (PPV) via tracheostomy at home.METHODS: We retrospectively reviewed medical charts of patients with severe BPD who were PPV dependent at home and who were enrolled in a university-affiliated home ventilator program between 1984 and 2010. We excluded patients with other comorbidities that could contribute to the development of chronic respiratory failure. We reported the incidence of these children in Indiana and cumulative incidences of survival, liberation from PPV, and decannulation.RESULTS: Over 27 years, 628 children were cared for in our home ventilator program. Of these, 102 patients met inclusion criteria: 83 (81.4%) were alive and 19 (18.6%) were deceased. Sixty-nine patients (67.6%) were liberated from PPV, and 97.1% of them were weaned before their fifth birthday, with a median age at liberation of 24 months (interquartile range, 19-33). Similarly, 60 patients (58.8%) were decannulated, of which 96.7% completed this process before their sixth birthday, with a median age at decannulation of 37.5 months (interquartile range, 31.5-45). The incidence of children with chronic respiratory failure secondary to BPD who were PPV-dependent at home in Indiana was 1.23 per 100 000 live births in 1984 and increased to 4.77 per 100 000 live births in 2010.CONCLUSIONS: Although extreme prematurity associated with severe BPD necessitating PPV at home carries significant risks of morbidity and mortality, successful liberation from mechanical ventilation and decannulation are likely to occur.