Section of Pediatric Pulmonology, Indiana University School of Medicine, Indianapolis, IN, USA.
Pediatrics. 2013 Sep;132(3):e727-34. doi: 10.1542/peds.2012-2990. Epub 2013 Aug 5.
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.
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.
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.
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.
描述在家经气管切开行慢性正压通气（PPV）治疗的严重支气管肺发育不良（BPD）继发慢性呼吸衰竭患儿的发病率和结局。
我们回顾性分析了 1984 年至 2010 年期间参加大学附属家庭通气计划的在家中接受依赖 PPV 治疗的严重 BPD 患儿的病历。我们排除了其他可能导致慢性呼吸衰竭的合并症。我们报告了印第安纳州此类患儿的发病率以及存活率、脱离 PPV 治疗和拔管的累积发生率。
在 27 年期间，有 628 名儿童在我们的家庭通气计划中接受治疗。其中，102 名患者符合纳入标准：83 名（81.4%）存活，19 名（18.6%）死亡。69 名（67.6%）患者脱离了 PPV 治疗，其中 97.1%在 5 岁生日前成功撤机，中位撤机年龄为 24 个月（四分位距，19-33）。同样，60 名患者（58.8%）拔管，其中 96.7%在 6 岁生日前完成了这一过程，中位拔管年龄为 37.5 个月（四分位距，31.5-45）。1984 年印第安纳州在家中依赖 PPV 治疗的 BPD 继发慢性呼吸衰竭患儿的发病率为每 10 万活产儿 1.23 例，2010 年增至每 10 万活产儿 4.77 例。
尽管与严重 BPD 相关的极早产患儿需要在家中接受 PPV 治疗，这会带来显著的发病率和死亡率风险，但仍有可能成功脱离机械通气和拔管。
