Qualitative indications for tracheostomy and chronic mechanical ventilation in patients with severe bronchopulmonary dysplasia

Yallapragada, Sushmita; Savani, Rashmin C.; MÅ«noz-Blanco, Sara; Lagatta, Joanne M.; Truog, William E.; Porta, Nicolas F. M.; Nelin, Leif D.; Zhang, Huayan; Vyas-Read, Shilpa; DiGeronimo, Robert; Natarajan, Girija; Wymore, Erica; Haberman, Beth; Machry, Joana; Potoka, Karin; Murthy, Karna

BACKGROUND: The decision to pursue chronic mechanical ventilation involves a complex mix of clinical and social considerations. Understanding the medical indications to pursue tracheostomy would reduce the ambiguity for both providers and families and facilitate focus on appropriate clinical goals. OBJECTIVE: To describe potential indications to pursue tracheostomy and chronic mechanical ventilation in infants with severe BPD (sBPD). STUDY DESIGN: We surveyed centers participating in the Children’s Hospitals Neonatal Consortium to describe their approach to proceed with tracheostomy in infants with sBPD. We requested a single representative response per institution. Question types were fixed form and free text responses. RESULTS: The response rate was high (31/34, 91%). Tracheostomy was strongly considered when: airway malacia was present, PCO(2) ≥ 76–85 mmHg, FiO(2) ≥ 0.60, PEEP ≥ 9–11 cm H(2)O, respiratory rate ≥ 61–70 breaths/min, PMA ≥ 44 weeks, and weight <10th %ile at 44 weeks PMA. CONCLUSIONS: Understanding the range of indications utilized by high level NICUs around the country to pursue a tracheostomy in an infant with sBPD is one step toward standardizing consensus indications for tracheostomy in the future.