Optimizing ventilator support in severe bronchopulmonary dysplasia in the absence of conclusive evidence

Miller, Audrey N.; Kielt, Matthew J.; El-Ferzli, George T.; Nelin, Leif D.; Shepherd, Edward G.

doi:10.3389/fped.2022.1022743

Cited by 9 publications

(6 citation statements)

References 38 publications

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“…weeks PMA and has failed multiple extubation attempts. 46 Children needing tracheostomy and those with bronchopulmonary dysplasia with pulmonary hypertension have significant mortality. 10,47 ATS has published a guideline to support ventilation settings for those on home ventilation via tracheostomy.…”

Section: Discussionmentioning

confidence: 99%

“…There is widespread variation in this practice and Murphy et al, reported that the center itself is the most distinctive factor in initiating home tracheostomy ventilation 45 . Audrey et al, recommended that tracheostomy may be attempted on the neonatal unit after an infant reaches the age of 52 weeks PMA and has failed multiple extubation attempts 46 . Children needing tracheostomy and those with bronchopulmonary dysplasia with pulmonary hypertension have significant mortality 10,47 .…”

Section: Discussionmentioning

confidence: 99%

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Types of home respiratory support in children with bronchopulmonary dysplasia and factors determining its duration: A scoping review

Zafar,

Hall

2024

Pediatric Pulmonology

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Bronchopulmonary dysplasia also known as chronic lung disease of prematurity has changed as a disease entity over the last five decades and children with “new bronchopulmonary dysplasia (BPD)” have better survival rates. This necessitates strategies to prevent severe BPD and provide organized home support. Home respiratory support in these children varies from home oxygen to noninvasive ventilation and tracheostomy ventilation. This review was conducted utilizing Joanna Briggs Institute publications on evidence synthesis and presentation of results for a scoping review. The Preferred Reporting Items for Systematic Review and Meta‐Analyses were used to report the results. The risk of bias assessment was done using “The Cochrane Handbook for Systematic Reviews tool for interventional studies.” After screening for the duplication of results and applying inclusion and exclusion criteria, twenty‐seven studies were assessed by reading the full texts. Out of these, eleven were finally included in this systematic review. The total sample size from all studies was 4794, including 2705 males. The 4/11 studies home oxygen, one study reported continuous positive airway pressure/bilevel positive airway pressure and seven studies used tracheostomy or tracheostomy ventilation. The median duration of post‐natal invasive ventilation was higher in those discharged on home oxygen compared to those who did not need oxygen at discharge. There is a significant proportion of children who are tracheostomy ventilated (8.65%) at home. In the absence of established guidelines, these children are vulnerable when it comes to care at home and the timing of decannulation. For home oxygen alone, guidelines by ERS, ATS and BTS have streamlined weaning protocols and the need for having a multi‐disciplinary team to care for these children.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Types of home respiratory support in children with bronchopulmonary dysplasia and factors determining its duration: A scoping review

Zafar,

Hall

2024

Pediatric Pulmonology

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“…16 Rapid ventilator weaning can result in atelectasis, worsening gas exchange, escalating FiO 2 requirements, and increased work of breathing. 29 The optimal timing and indications for tracheostomy are not known but the most common indications for tracheostomy are airway pathology and need for ventilation. 30…”

Section: Inpatient Managementmentioning

confidence: 99%

“…Infants with established severe BPD and heterogenous lung disease require a change in ventilation strategy to a slower rate, higher iT, high TV, and adequate PEEP, which often requires careful titration if severe airway malacia is present 16 . Rapid ventilator weaning can result in atelectasis, worsening gas exchange, escalating FiO 2 requirements, and increased work of breathing 29 . The optimal timing and indications for tracheostomy are not known but the most common indications for tracheostomy are airway pathology and need for ventilation 30 …”

Section: Bronchopulmonary Dysplasiamentioning

confidence: 99%

ATS core curriculum 2023. Pediatric pulmonary medicine: Respiratory disorders in infants

Leon‐Astudillo,

Dy,

McCown

et al. 2024

Pediatric Pulmonology

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The American Thoracic Society Core Curriculum updates clinicians annually in pediatric pulmonary disease. This is a summary of the Pediatric Pulmonary Medicine Core Curriculum presented at the 2023 American Thoracic Society International Conference. The respiratory disorders of infancy discussed in this year's review include: the care of the patient with bronchopulmonary dysplasia in the neonatal intensive care unit, clinical phenotypes and comorbidities; diffuse lung disease; pulmonary hypertension; central and obstructive sleep apnea. The care of infants with respiratory disorders often poses significant challenges to the general pediatric pulmonologist, sleep clinician, and neonatologist. This review aims to highlight the most clinically relevant aspects of the evaluation, management, and outcomes of infants with these key respiratory disorders, while emphasizing the importance of multidisciplinary care. Furthermore, this document summarizes essential aspects of genetic testing, novel imaging and treatment modalities, and includes multiple resources for clinical practice.

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“…The timing of tracheostomy placement often involves waiting for multiple failed attempts at weaning from mechanical ventilation [ 12 , 44 ]. The notion that “we should try one more time” often underlies this and is a deliberate attempt to avoid tracheostomy given the risks for mortality and morbidity as well as the implications for parents and caregivers of a technology dependent infant.…”

Section: Tracheostomy Decision Makingmentioning

confidence: 99%

Tracheostomy in Severe Bronchopulmonary Dysplasia—How to Decide in the Absence of Evidence

Miller,

Shepherd,

Manning

et al. 2023

Biomedicines

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Infants with the most severe forms of bronchopulmonary dysplasia (BPD) may require long-term invasive positive pressure ventilation for survival, therefore necessitating tracheostomy. Although life-saving, tracheostomy has also been associated with high mortality, postoperative complications, high readmission rates, neurodevelopmental impairment, and significant caregiver burden, making it a highly complex and challenging decision. However, for some infants tracheostomy may be necessary for survival and the only way to facilitate a timely and safe transition home. The specific indications for tracheostomy and the timing of the procedure in infants with severe BPD are currently unknown. Hence, centers and clinicians display broad variations in practice with regard to tracheostomy, which presents barriers to designing evidence-generating studies and establishing a consensus approach. As the incidence of severe BPD continues to rise, the question remains, how do we decide on tracheostomy to provide optimal outcomes for these patients?

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Optimizing ventilator support in severe bronchopulmonary dysplasia in the absence of conclusive evidence

Cited by 9 publications

References 38 publications

Types of home respiratory support in children with bronchopulmonary dysplasia and factors determining its duration: A scoping review

Types of home respiratory support in children with bronchopulmonary dysplasia and factors determining its duration: A scoping review

ATS core curriculum 2023. Pediatric pulmonary medicine: Respiratory disorders in infants

Tracheostomy in Severe Bronchopulmonary Dysplasia—How to Decide in the Absence of Evidence

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