气管切开术及呼吸机依赖婴儿的呼吸、生长和生存结局
Respiratory, growth, and survival outcomes of infants with tracheostomy and ventilator dependence.
作者信息
Akangire Gangaram, Taylor Jane B, McAnany Susan, Noel-MacDonnell Janelle, Lachica Charisse, Sampath Venkatesh, Manimtim Winston
机构信息
Division of Neonatology, Children's Mercy Kansas City, Kansas City, MO, USA.
Department of Pediatrics, School of Medicine, University of Missouri Kansas City, Kansas City, MO, USA.
出版信息
Pediatr Res. 2021 Aug;90(2):381-389. doi: 10.1038/s41390-020-01183-x. Epub 2020 Oct 3.
BACKGROUND
Outcome of infants with tracheostomy have not been well described in the literature. Our objective was to describe the respiratory, growth, and survival outcomes of infants with tracheostomy.
METHODS
A retrospective study was conducted on 204 infants born between 2005 and 2015 with tracheostomy at <1 year of age and follow-up in the Infant Tracheostomy and Home Ventilator Clinic up to 4 years of age.
RESULTS
The mean age at tracheostomy was 4.5 months with median age of 3 months. Median age of decannulation was 32 months. The time from tracheostomy placement to complete discontinuation of mechanical ventilation was 15.4 months and from tracheostomy to decannulation was 33.8 months. Mortality rate was 21% and median age of death was 18 months. Preterm infants with acquired airway and lung disease (BPD) and born at <28 weeks' gestation had a significantly higher survival rate compared to term infants. The z-scores for weight and weight for length improved from the time of discharge (mean chronological age 6.5 months) to first year and remained consistent through 3 years.
CONCLUSIONS
Premature infants had a higher rate of discontinuation of mechanical ventilation and decannulation compared to term infants. These infants showed consistent growth and comparable survival rate.
IMPACT
Infants with tracheostomy and ventilator dependence followed in a multidisciplinary clinic model may have improved survival, growth, and earlier time to decannulation. Preterm infants with acquired airway and lung disease (BPD) with tracheostomy had a higher survival rate compared to term infants with various tracheostomy indications. The age at tracheostomy in infants was 4.5 months and of decannulation was 37 months. Time from tracheostomy to complete discontinuation of mechanical ventilation was 15.4 months. Addition of this data to the sparse literature will be crucial in counseling the families and education of medical staff.
背景
文献中对气管造口术婴儿的预后描述欠佳。我们的目的是描述气管造口术婴儿的呼吸、生长和生存预后。
方法
对2005年至2015年间出生且1岁前接受气管造口术、并在婴儿气管造口术和家庭呼吸机诊所随访至4岁的204例婴儿进行了一项回顾性研究。
结果
气管造口术的平均年龄为4.5个月，中位年龄为3个月。拔管的中位年龄为32个月。从气管造口术置管到机械通气完全停用的时间为15.4个月，从气管造口术到拔管的时间为33.8个月。死亡率为21%，死亡中位年龄为18个月。与足月儿相比，患有获得性气道和肺部疾病（支气管肺发育不良）且孕周<28周的早产儿生存率显著更高。体重和身长体重的z评分从出院时（平均实际年龄6.5个月）到1岁时有所改善，并在3年内保持稳定。
结论
与足月儿相比，早产儿机械通气停用和拔管率更高。这些婴儿生长稳定，生存率相当。
影响
在多学科诊所模式下随访的气管造口术和呼吸机依赖婴儿可能有更高的生存率、更好的生长情况以及更早的拔管时间。与有各种气管造口术指征的足月儿相比，患有获得性气道和肺部疾病（支气管肺发育不良）且接受气管造口术的早产儿生存率更高。婴儿气管造口术的年龄为4.5个月，拔管年龄为37个月。从气管造口术到机械通气完全停用的时间为15.4个月。将这些数据补充到稀少的文献中对于为家庭提供咨询和医护人员教育至关重要。
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