Agarwal Amit, Manimtim Winston M, Alexiou Stamatia, Abman Steven H, Akangire Gangaram, Aoyama Brianna C, Austin Eric D, Baker Christopher D, Bansal Manvi, Bauer Sarah E, Cristea A Ioana, Dawson Sara K, Fierro Julie L, Hayden Lystra P, Henningfeld Jennifer K, Kaslow Jacob A, Lai Khanh V, Levin Jonathan C, McKinney Robin L, Miller Audrey N, Nelin Leif D, Popova Antonia P, Siddaiah Roopa, Tracy Michael C, Villafranco Natalie M, McGrath-Morrow Sharon A, Collaco Joseph M
Division of Pulmonary Medicine, Arkansas Children's Hospital and University of Arkansas for Medical Sciences, Little Rock, AR, USA.
Division of Neonatology, Children's Mercy-Kansas City and University of Missouri Kansas City School of Medicine, Kansas, MO, USA.
J Perinatol. 2024 Jul 31. doi: 10.1038/s41372-024-02078-z.
To identify factors associated with the timing of ventilator liberation and tracheostomy decannulation among infants with severe bronchopulmonary dysplasia (sBPD) who required chronic outpatient invasive ventilation.
Multicenter retrospective study of 154 infants with sBPD on outpatient ventilators. Factors associated with ventilator liberation and decannulation were identified using Cox regression models and multilevel survival models.
Ventilation liberation and decannulation occurred at median ages of 27 and 49 months, respectively. Older age at transition to a portable ventilator and at discharge, higher positive end expiratory pressure, and multiple respiratory readmissions were associated with delayed ventilator liberation. Surgical management of gastroesophageal reflux was associated with later decannulation.
Ventilator liberation timing was impacted by longer initial admissions and higher ventilator pressure support needs, whereas decannulation timing was associated with more aggressive reflux management. Variation in the timing of events was primarily due to individual-level factors, rather than center-level factors.
确定在需要长期门诊有创通气的重度支气管肺发育不良（sBPD）婴儿中，与呼吸机撤机时机和气管造口拔管相关的因素。
对154例使用门诊呼吸机的sBPD婴儿进行多中心回顾性研究。使用Cox回归模型和多水平生存模型确定与呼吸机撤机和拔管相关的因素。
呼吸机撤机和拔管的中位年龄分别为27个月和49个月。过渡到便携式呼吸机时和出院时年龄较大、呼气末正压较高以及多次呼吸再入院与呼吸机撤机延迟有关。胃食管反流的手术治疗与拔管延迟有关。
呼吸机撤机时机受初始住院时间较长和呼吸机压力支持需求较高的影响，而拔管时机与更积极的反流管理有关。事件发生时间的差异主要归因于个体水平因素，而非中心水平因素。
