Abstract
Background:
The Comprehensive Center for Bronchopulmonary Dysplasia (CCBPD) is a referral center for term and post-term patients with severe BPD. The CCBPD strongly promotes family centered care. The focus of this population of patients has allowed for successful long term NCPAP. There is little data regarding the optimal timing for the decision of a tracheostomy in this patient population. To standardize decision making, the team identified key concepts that would be evaluated and scored. An objective scoring tool of important factors was created in 2015 that reflect three areas of concern: factors likely to prolong the need of ongoing positive pressure, exposure to negative metabolic influences to achieve respiratory stability, and direct restrictions of developmental progress or experiences. Infants are scored monthly from 44 weeks corrected gestational age onward. Scoring includes 16 factors for infants on mechanical ventilation and CPAP. The total score is evaluated by zones: green for low risk, yellow for caution, and red reflecting likely need unless progress occurs soon. Scores and concerns are shared with family of infants whom score in the yellow or caution zone, as well as progression to the red zone.
Methods:
The goals for this tool was to decrease variation in the decision making for tracheostomy and to aid parents in understanding the factors that are considered for this decision. Members of the CCBPD team from each discipline were asked to respond to a survey regarding this scoring tool.
Results:
81.25% of the team agreed that the tracheostomy scoring tool is easy to calculate.87.50% agreed that the tracheostomy guidelines are helpful in presenting the concerns of needing and benefiting from tracheostomy placement as an interdisciplinary team.68.75% agreed that the guidelines make the decision making for family easier and less controversial.68.75% agreed that the guidelines have improved overall best outcomes.
Conclusions:
The interdisciplinary team developed a scoring tool to reflect the three major concerns for need of a tracheostomy. The team provides an objective assessment determining the best timing for the decision of tracheostomy placement that provides a standardized approach to help parents understand why a tracheostomy might be recommended. Utilization of this scoring tool has helped decrease variability of decision making, anticipate discussions with family, and follow our outcomes over time for the severe BPD population.
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