Retrospective Analysis of an Interdisciplinary Ventilator Care Program Intervention on Survival of Infants with Ventilator-Dependent Bronchopulmonary Dysplasia

Abstract

Background The clinical needs of infants with severe bronchopulmonary dysplasia (BPD) that remain ventilator-dependent are complex, and management strategies that optimize survival and long-term outcomes controversial. We hypothesized that an interdisciplinary ventilator care program (VCP), committed to the care of this population will improve survival through standardized approaches to cardiopulmonary care and related comorbidities, enhanced communication, and continuity of care. Methods Retrospective chart reviews were performed on patients at Children’s Hospital Colorado’s neonatal intensive care unit, who underwent tracheostomy placement between 2000 and 2013. Data were collected for two time periods: 2000 to 2005 and 2006 to 2013, before and after initiation of the VCP. Collected data on infants with ventilator-dependent BPD included: gestational age (GA), age at tracheostomy, respiratory severity score (RSS; mean airway pressure [MAP] × fraction of inspired oxygen [FiO2]), comorbidities, medication use, and the age of death. Tracheostomy patients without severe BPD were excluded. Results Despite no difference, pre and post VCP regarding GA, birth weight or morbidities and survival to discharge increased from 50% to 85% after implementation of the VCP (p < 0.05). Between period 1 and 2, there were differences in systemic and inhaled steroid use and mucolytic use. Conclusion These findings suggest an interdisciplinary approach to the care of infants with ventilator-dependent BPD can improve survival.

Respiratory, growth, and survival outcomes of infants with tracheostomy and ventilator dependence

“… 11 Most children’s hospitals have moved toward a dedicated multidisciplinary care model with a ventilator care program for this vulnerable population; however, outcome data for these infants are scarce in the literature. 7 , 11 …”

“…These findings have prompted children’s hospitals to develop dedicated teams to care for these infants, not only during their initial inpatient stay but also on an outpatient basis in collaborative multidisciplinary teams involving several pediatric specialties. 7 The varying outcomes reported have led to confusion about the optimal management of these infants who require long-term ventilation, with some neonatal intensive care units (NICUs) preferring long-term intubation over tracheostomy and home discharge. 1 , 8 Significant variation in practice has led to conflicting opinions on indications, feasibility, and long-term prognosis of infants <1 year old undergoing tracheostomy.…”

Bronchopulmonary Dysplasia: a Multidisciplinary Approach to Management

“…GER combined with oral-motor immaturity increases the risk of aspiration. Repeated aspiration events may trigger BPD exacerbations and pulmonary hypertensive crises or cause decompensation due to tracheitis or pneumonia [12]. In the short term, some infants may benefit from continuous duodenal feeds.…”

Predictors of length of stay for initial hospitalization in infants with bronchopulmonary dysplasia

“…However, targeted inventions can certainly have a large beneficial effect on specific subgroups. For example, a recent effort in Colorado to standardize initial discharge of pediatric ventilated patients resulted in substantial reduction in mortality, length of stay, and costs [19, 29]. …”