Akangire Gangaram, Manimtim Winston
Division of Neonatology, Children's Mercy Kansas City, Kansas City, MO, United States.
Department of Pediatrics, School of Medicine, University of Missouri-Kansas City, Kansas City, MO, United States.
Front Pediatr. 2023 Jan 12;10:1066367. doi: 10.3389/fped.2022.1066367. eCollection 2022.
In recent years, with increased survival of infants with severe bronchopulmonary dysplasia (BPD), long term ventilation due to severe BPD has increased and become the most common indication for tracheostomy in infants less than one year of age. Evidence shows that tracheostomy in severe BPD may improve short- and long-term respiratory and neurodevelopmental outcomes. However, there is significant variation among centers in the indication, timing, intensive care management, and follow-up care after hospital discharge of infants with severe BPD who received tracheostomy for chronic ventilation. The timing of liberation from the ventilator, odds of decannulation, rate of rehospitalization, growth, and neurodevelopment are all clinically important outcomes that can guide both clinicians and parents to make a well-informed decision when choosing tracheostomy and long-term assisted ventilation for infants with severe BPD. This review summarizes the current literature regarding the indications and timing of tracheostomy placement in infants with severe BPD, highlights center variability in both intensive care and outpatient follow-up settings, and describes outcomes of infants with severe BPD who received tracheostomy.
近年来，随着重度支气管肺发育不良（BPD）婴儿存活率的提高，因重度BPD导致的长期通气情况增多，且成为1岁以下婴儿气管切开术最常见的适应症。有证据表明，重度BPD患者进行气管切开术可能改善短期和长期的呼吸及神经发育结局。然而，对于因慢性通气而接受气管切开术的重度BPD婴儿，各中心在适应症、时机、重症监护管理及出院后随访护理方面存在显著差异。脱机时机、拔管几率、再住院率、生长情况及神经发育都是临床上重要的结局指标，可为临床医生和家长在为重度BPD婴儿选择气管切开术和长期辅助通气时提供充分信息，以做出明智决策。本综述总结了有关重度BPD婴儿气管切开术适应症和时机的当前文献，强调了重症监护和门诊随访环境中的中心差异，并描述了接受气管切开术的重度BPD婴儿的结局。
