Skip to main content

Thank you for visiting nature.com. You are using a browser version with limited support for CSS. To obtain the best experience, we recommend you use a more up to date browser (or turn off compatibility mode in Internet Explorer). In the meantime, to ensure continued support, we are displaying the site without styles and JavaScript.

  • Article
  • Published:

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

Journal of Perinatology volume 41, pages 2651–2657 (2021)Cite this article

Subjects

Abstract

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, PCO2 ≥ 76–85 mmHg, FiO2 ≥ 0.60, PEEP ≥ 9–11 cm H2O, 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.

This is a preview of subscription content, access via your institution

Access options

Buy this article

  • Purchase on SpringerLink
  • Instant access to the full article PDF.

USD 39.95

Prices may be subject to local taxes which are calculated during checkout

Fig. 1: Most common criteria for tracheostomy placement.

Similar content being viewed by others

References

  1. Bamat NA, Kirpalani H, Feudtner C, Jensen E, Laughon M, Zhang H, et al. Medication use in infants with severe bronchopulmonary dysplasia admitted to United States children’s hospitals. J Perinatol. 2019;39:1291–99.

  2. Ehrenkranz RA, Walsh MC, Vohr BR, Jobe A, Wright L, Fanaroff A, et al. Validation of the National Institutes of Health consensus definition of bronchopulmonary dysplasia. Pediatrics. 2005;116:1353–60.

    Article  Google Scholar 

  3. Jensen EA, Dysart K, Gantz MG, McDonald S, Barnat N, Keszler M, et al. The Diagnosis of Bronchopulmonary Dysplasia in Very Preterm Infants: an evidence-based approach. Am J Respir Crit Care Med. 2019;200:751–9.

  4. Murthy K, Savani RC, Lagatta JM, Zaniletti I, Wadhawan R, Truog W, et al. Predicting death or tracheostomy placement in infants with severe bronchopulmonary dysplasia. J Perinatol. 2014;34:543–8.

    Article  CAS  Google Scholar 

  5. Luo J, Shepard S, Nilan K, Wood A, Monk H, Jensen E, et al. Improved growth and developmental activity post tracheostomy in preterm infants with severe BPD. Pediatr Pulmonol. 2018;53:1237–44.

    Article  Google Scholar 

  6. Cammack B, Noel-MacDonnell J, Cuna A, Manimtim W. Impact of tracheostomy on language and cognitive development in infants with severe bronchopulmonary dysplasia. J Perinatol. 2020;40:299–305.

    Article  CAS  Google Scholar 

  7. Sobotka SA, Hird-McCorry LP, Goodman DM. Identification of Fail Points for Discharging Pediatric Patients With New Tracheostomy and Ventilator. Hosp Pediatr. 2016;6:552–7.

    Article  Google Scholar 

  8. Berry JG, Goodman DM, Coller RJ, Agrawal R, Kuo D, Cohen E, et al. Association of Home Respiratory Equipment and Supply Use with Health Care Resource Utilization in Children. J Pediatr. 2019;207:169–75 e162.

    Article  Google Scholar 

  9. Maynard R, Christensen E, Cady R, Jacob A, Ouellette Y, Podgorski H, et al. Home Health Care Availability and Discharge Delays in Children With Medical Complexity. Pediatrics. 2019;143:e20181951.

  10. Wallis C, Paton JY, Beaton S, Jardine E. Children on long-term ventilatory support: 10 years of progress. Arch Dis Child. 2011;96:998–1002.

    Article  CAS  Google Scholar 

  11. McDougall CM, Adderley RJ, Wensley DF, Seear MD. Long-term ventilation in children: longitudinal trends and outcomes. Arch Dis Child. 2013;98:660–5.

    Article  Google Scholar 

  12. Rasooly IR, Shults J, Guevara JP, Feudtner C. State Variation in Posthospital Home Nursing for Commercially Insured Medically Complex Children. Pediatrics. 2020;146:e20192465.

  13. Sobotka SA, Gaur DS, Goodman DM, Agrawal RK, Berry JG, Graham RJ. Pediatric patients with home mechanical ventilation: the health services landscape. Pediatr Pulmonol. 2019;54:40–6.

    Article  Google Scholar 

  14. Murthy K, Dykes FD, Padula MA, Pallotto EK, Reber KM, Durand DJ, et al. The Children’s Hospitals Neonatal Database: an overview of patient complexity, outcomes and variation in care. J Perinatol. 2014;34:582–6.

    Article  CAS  Google Scholar 

  15. American Academy of Pediatrics Committee on Fetus And Newborn Levels of Neonatal Care: committee on Fetus and Newborn. Pediatrics. 2012;130:587–97.

    Article  Google Scholar 

  16. Hsieh HF, Shannon SE. Three approaches to qualitative content analysis. Qual Health Res. 2005;15:1277–88.

    Article  Google Scholar 

  17. Engle WA. American Academy of Pediatrics Committee on F, Newborn. Age terminology during the perinatal period. Pediatrics 2004;114:1362–4.

    Article  Google Scholar 

  18. Natarajan G, Pappas A, Shankaran S, Kendrick D, Das A, Higgins R, et al. Outcomes of extremely low birth weight infants with bronchopulmonary dysplasia: impact of the physiologic definition. Early Hum Dev. 2012;88:509–15.

    Article  Google Scholar 

  19. Bhandari A, Bhandari V. Pitfalls, problems, and progress in bronchopulmonary dysplasia. Pediatrics. 2009;123:1562–73.

    Article  Google Scholar 

  20. Karkoutli AA, Brumund MR, Evans AK. Bronchopulmonary dysplasia requiring tracheostomy: a review of management and outcomes. Int J Pediatr Otorhinolaryngol. 2020;139:110449.

    Article  Google Scholar 

  21. Klemm E, Nowak AK. Tracheotomy-Related Deaths. Dtsch Arztebl Int. 2017;114:273–9.

    PubMed  PubMed Central  Google Scholar 

  22. Watters K, O’Neill M, Zhu H, Graham RJ, Hall M, Berry J. Two-year mortality, complications, and healthcare use in children with medicaid following tracheostomy. Laryngoscope. 2016;126:2611–7.

    Article  Google Scholar 

  23. Watters KF. Tracheostomy in Infants and Children. Respir Care. 2017;62:799–825.

    Article  Google Scholar 

  24. Wirtz N, Tibesar RJ, Lander T, Sidman J. A Pediatric Decannulation Protocol: outcomes of a 10-Year Experience. Otolaryngol Head Neck Surg. 2016;154:731–4.

    Article  Google Scholar 

  25. Henningfeld JK, Maletta K, Ren B, Richards KL, Wegner C, D’Andrea LA. Liberation from home mechanical ventilation and decannulation in children. Pediatr Pulmonol. 2016;51:838–49.

    Article  Google Scholar 

  26. Treaster J. Cost President cite for Girl's Treatment is Described as 'Low'. New York Times, 1981. p. 25.

  27. USDoHaH. Report of the Surgeon General's Workshop on Children with Handicaps and Their Families. Case Example: The Ventilator Dependent Child. United State Public Health Service. Division of Maternal and Child Health. 1983.

  28. Sobotka SA, Foster C, Lynch E, Hird-McCorry L, Goodman DM. Attributable Delay of Discharge for Children with Long-Term Mechanical Ventilation. J Pediatr. 2019;212:166–71.

    Article  Google Scholar 

  29. Quint RD, Chesterman E, Crain LS, Winkleby M, Boyce WT. Home care for ventilator-dependent children. Psychosocial impact on the family. Am J Dis Child. 1990;144:1238–41.

    Article  CAS  Google Scholar 

  30. Patterson JM, Leonard BJ, Titus JC. Home care for medically fragile children: impact on family health and well-being. J Dev Behav Pediatr. 1992;13:248–55.

    Article  CAS  Google Scholar 

  31. Petr CG, Murdock B, Chapin R. Home care for children dependent on medical technology: the family perspective. Soc Work Health Care. 1995;21:5–22.

    Article  CAS  Google Scholar 

  32. Thyen U, Terres NM, Yazdgerdi SR, Perrin JM. Impact of long-term care of children assisted by technology on maternal health. J Dev Behav Pediatr. 1998;19:273–82.

    Article  CAS  Google Scholar 

  33. Thyen U, Kuhlthau K, Perrin JM. Employment, child care, and mental health of mothers caring for children assisted by technology. Pediatrics. 1999;103:1235–42.

    Article  CAS  Google Scholar 

  34. Sterni LM, Collaco JM, Baker CD, Carroll J, Sharma G, Brozek J, et al. An Official American Thoracic Society Clinical Practice Guideline: pediatric chronic home invasive ventilation. Am J Respir Crit Care Med. 2016;193:e16–35.

    Article  Google Scholar 

  35. Moore PE, Boyer D, O’Connor MG, Baker C, Rettig J, Sterni L, et al. Pediatric Chronic Home Invasive Ventilation. Ann Am Thorac Soc. 2016;13:1170–2.

    Article  Google Scholar 

Download references

Funding

None. RCS holds the William Buchanan Chair in Pediatrics at UT Southwestern.

Author information

Authors and Affiliations

  1. UT Southwestern Medical Center, Dallas, TX, USA

    Sushmita Yallapragada, Rashmin C. Savani & Sara Mūnoz-Blanco

  2. Medical College of Wisconsin, Milwaukee, WI, USA

    Joanne M. Lagatta

  3. Children’s Mercy-Kansas City and the University of Missouri-Kansas City School of Medicine, Kansas City, MO, USA

    William E. Truog

  4. Northwestern University & Ann and Robert H. Lurie Children’s Hospital of Chicago, Chicago, IL, USA

    Nicolas F. M. Porta & Karna Murthy

  5. Nationwide Children’s Hospital, Columbus, OH, USA

    Leif D. Nelin

  6. Children’s Hospital of Philadelphia, Philadelphia, PA, USA

    Huayan Zhang

  7. Emory University, Atlanta, GA, USA

    Shilpa Vyas-Read

  8. Seattle Children’s Hospital/University of Washington, Seattle, WA, USA

    Robert DiGeronimo

  9. Children’s Hospital of Michigan, Detroit, MI, USA

    Girija Natarajan

  10. University of Colorado, Aurora, CO, USA

    Erica Wymore

  11. Cincinnati Children’s Hospital Medical Center, Cincinnati, OH, USA

    Beth Haberman

  12. Johns Hopkins All Children’s Hospital, St. Petersburg, FL, USA

    Joana Machry

  13. Akron Children’s Hospital, Akron, OH, USA

    Karin Potoka

Authors
  1. Sushmita Yallapragada
    View author publications

    Search author on:PubMed Google Scholar

  2. Rashmin C. Savani
    View author publications

    Search author on:PubMed Google Scholar

  3. Sara Mūnoz-Blanco
    View author publications

    Search author on:PubMed Google Scholar

  4. Joanne M. Lagatta
    View author publications

    Search author on:PubMed Google Scholar

  5. William E. Truog
    View author publications

    Search author on:PubMed Google Scholar

  6. Nicolas F. M. Porta
    View author publications

    Search author on:PubMed Google Scholar

  7. Leif D. Nelin
    View author publications

    Search author on:PubMed Google Scholar

  8. Huayan Zhang
    View author publications

    Search author on:PubMed Google Scholar

  9. Shilpa Vyas-Read
    View author publications

    Search author on:PubMed Google Scholar

  10. Robert DiGeronimo
    View author publications

    Search author on:PubMed Google Scholar

  11. Girija Natarajan
    View author publications

    Search author on:PubMed Google Scholar

  12. Erica Wymore
    View author publications

    Search author on:PubMed Google Scholar

  13. Beth Haberman
    View author publications

    Search author on:PubMed Google Scholar

  14. Joana Machry
    View author publications

    Search author on:PubMed Google Scholar

  15. Karin Potoka
    View author publications

    Search author on:PubMed Google Scholar

  16. Karna Murthy
    View author publications

    Search author on:PubMed Google Scholar

Consortia

Children’s Hospital Neonatal Consortium severe bronchopulmonary dysplasia subgroup

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

Contributions

SY, RCS, JL, WT, NP and KM contributed to the design and implementation of the survey, as well as writing and reviewing the paper. SMB provided key qualitative research input and reviewed the paper. LN, HZ, SVR contributed to the design of the survey as well as editing the paper. RD, GN, EW, BH, JM, KP contributed to writing and editing of this paper.

Corresponding author

Correspondence to Sushmita Yallapragada.

Ethics declarations

Competing interests

Dr KM is Chair and Board Member of CHNC, a 501(c)3 organization.

Additional information

Publisher’s note Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

*Members of the Children’s Hospital Neonatal Consortium severe bronchopulmonary dysplasia subgroup are listed below Funding.

Supplementary information

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Yallapragada, S., Savani, R.C., Mūnoz-Blanco, S. et al. Qualitative indications for tracheostomy and chronic mechanical ventilation in patients with severe bronchopulmonary dysplasia. J Perinatol 41, 2651–2657 (2021). https://doi.org/10.1038/s41372-021-01165-9

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Version of record:

  • Issue date:

  • DOI: https://doi.org/10.1038/s41372-021-01165-9

This article is cited by

Search

Advanced search

Quick links