Factors associated with liberation from home mechanical ventilation and tracheostomy decannulation in infants and children with severe bronchopulmonary dysplasia

Amit Agarwal¹, Winston M Manimtim², Stamatia Alexiou³, Steven H Abman⁴, Gangaram Akangire², Brianna C Aoyama⁵, Eric D Austin⁶, Christopher D Baker⁴, Manvi Bansal⁷, Sarah E Bauer⁸, A Ioana Cristea⁸, Sara K Dawson⁹, Julie L Fierro³, Lystra P Hayden¹⁰, Jennifer K Henningfeld⁹, Jacob A Kaslow⁶, Khanh V Lai¹¹, Jonathan C Levin^{10

12}, Robin L McKinney¹³, Audrey N Miller¹⁴, Leif D Nelin¹⁴, Antonia P Popova¹⁵, Roopa Siddaiah¹⁶, Michael C Tracy¹⁷, Natalie M Villafranco¹⁸, Sharon A McGrath-Morrow³, Joseph M Collaco⁵

Affiliations

¹ Division of Pulmonary Medicine, Arkansas Children's Hospital and University of Arkansas for Medical Sciences, Little Rock, AR, USA. AgarwalAmit@uams.edu.
² Division of Neonatology, Children's Mercy-Kansas City and University of Missouri Kansas City School of Medicine, Kansas, MO, USA.
³ Division of Pulmonary Medicine, Children's Hospital of Philadelphia and University of Pennsylvania, Philadelphia, PA, USA.
⁴ Section of Pulmonary and Sleep Medicine, Department of Pediatrics, University of Colorado School of Medicine, Aurora, CO, USA.
⁵ Eudowood Division of Pediatric Respiratory Sciences, Johns Hopkins University, Baltimore, MD, USA.
⁶ Pulmonary Medicine, Vanderbilt University and Vanderbilt University Medical Center, Nashville, TN, USA.
⁷ Pulmonology and Sleep Medicine, Children's Hospital of Los Angeles, Los Angeles, CA, USA.
⁸ Division of Pediatric Pulmonology, Allergy and Sleep Medicine, Riley Children's Hospital and Indiana University, Indianapolis, IN, USA.
⁹ Department of Pediatrics, Medical College of Wisconsin Milwaukee, Milwaukee, WI, USA.
¹⁰ Division of Pulmonary Medicine, Boston Children's Hospital and Harvard Medical School, Boston, MA, USA.
¹¹ Division of Pediatric Pulmonary and Sleep Medicine, University of Utah, Salt Lake City, UT, USA.
¹² Division of Newborn Medicine, Boston Children's Hospital and Harvard Medical School, Boston, MA, USA.
¹³ Department of Pediatrics, Brown University School of Medicine, Providence, RI, USA.
¹⁴ Division of Neonatology, Nationwide Children's Hospital and Ohio State University, Columbus, OH, USA.
¹⁵ Pediatric Pulmonology, University of Michigan, Ann Arbor, MI, USA.
¹⁶ Pediatric Pulmonology, Penn State Health, Hershey, PA, USA.
¹⁷ Division of Pediatric Pulmonary, Asthma and Sleep Medicine, Stanford University, Stanford, CA, USA.
¹⁸ Pulmonary Medicine, Texas Children's Hospital and Baylor College of Medicine, Houston, TX, USA.

PMID: 39085436
DOI: 10.1038/s41372-024-02078-z

Factors associated with liberation from home mechanical ventilation and tracheostomy decannulation in infants and children with severe bronchopulmonary dysplasia

Amit Agarwal et al. J Perinatol. 2024.

. 2024 Jul 31.

doi: 10.1038/s41372-024-02078-z. Online ahead of print.

Authors

Affiliations

¹ Division of Pulmonary Medicine, Arkansas Children's Hospital and University of Arkansas for Medical Sciences, Little Rock, AR, USA. AgarwalAmit@uams.edu.
² Division of Neonatology, Children's Mercy-Kansas City and University of Missouri Kansas City School of Medicine, Kansas, MO, USA.
³ Division of Pulmonary Medicine, Children's Hospital of Philadelphia and University of Pennsylvania, Philadelphia, PA, USA.
⁴ Section of Pulmonary and Sleep Medicine, Department of Pediatrics, University of Colorado School of Medicine, Aurora, CO, USA.
⁵ Eudowood Division of Pediatric Respiratory Sciences, Johns Hopkins University, Baltimore, MD, USA.
⁶ Pulmonary Medicine, Vanderbilt University and Vanderbilt University Medical Center, Nashville, TN, USA.
⁷ Pulmonology and Sleep Medicine, Children's Hospital of Los Angeles, Los Angeles, CA, USA.
⁸ Division of Pediatric Pulmonology, Allergy and Sleep Medicine, Riley Children's Hospital and Indiana University, Indianapolis, IN, USA.
⁹ Department of Pediatrics, Medical College of Wisconsin Milwaukee, Milwaukee, WI, USA.
¹⁰ Division of Pulmonary Medicine, Boston Children's Hospital and Harvard Medical School, Boston, MA, USA.
¹¹ Division of Pediatric Pulmonary and Sleep Medicine, University of Utah, Salt Lake City, UT, USA.
¹² Division of Newborn Medicine, Boston Children's Hospital and Harvard Medical School, Boston, MA, USA.
¹³ Department of Pediatrics, Brown University School of Medicine, Providence, RI, USA.
¹⁴ Division of Neonatology, Nationwide Children's Hospital and Ohio State University, Columbus, OH, USA.
¹⁵ Pediatric Pulmonology, University of Michigan, Ann Arbor, MI, USA.
¹⁶ Pediatric Pulmonology, Penn State Health, Hershey, PA, USA.
¹⁷ Division of Pediatric Pulmonary, Asthma and Sleep Medicine, Stanford University, Stanford, CA, USA.
¹⁸ Pulmonary Medicine, Texas Children's Hospital and Baylor College of Medicine, Houston, TX, USA.

PMID: 39085436
DOI: 10.1038/s41372-024-02078-z

Abstract

Objective: 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.

Study design: 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.

Results: 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.

Conclusions: 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.

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References

1. Abman SH, Collaco JM, Shepherd EG, Keszler M, Cuevas-Guaman M, Welty SE, et al. Interdisciplinary Care of Children with Severe Bronchopulmonary Dysplasia. J Pediatrics. 2017;181:12–28.e1. - DOI
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1. Manimtim WM, Agarwal A, Alexiou S, Levin JC, Aoyama B, Austin ED, et al. Respiratory Outcomes for Ventilator-Dependent Children With Bronchopulmonary Dysplasia. Pediatrics. 2023;151:e2022060651.
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Factors associated with liberation from home mechanical ventilation and tracheostomy decannulation in infants and children with severe bronchopulmonary dysplasia

Affiliations

Factors associated with liberation from home mechanical ventilation and tracheostomy decannulation in infants and children with severe bronchopulmonary dysplasia

Authors

Affiliations

Abstract

References

Grants and funding

LinkOut - more resources

Full Text Sources

Medical