Tracheostomy in Severe Bronchopulmonary Dysplasia-How to Decide in the Absence of Evidence.
Audrey N MillerEdward G ShepherdAmy ManningHumra ShamimTendy ChiangGeorge El-FerzliLeif D NelinPublished in: Biomedicines (2023)
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?
Keyphrases
- mechanical ventilation
- early onset
- acute respiratory distress syndrome
- intensive care unit
- healthcare
- risk factors
- newly diagnosed
- primary care
- ejection fraction
- type diabetes
- respiratory failure
- minimally invasive
- skeletal muscle
- coronary artery disease
- adipose tissue
- patient reported outcomes
- metabolic syndrome
- weight loss
- glycemic control
- congenital heart disease