Tracheostomy and Home Invasive Ventilation in Severe Bronchopulmonary Dysplasia: A Scoping Review of Indications, Timing, Outcomes and Transitional Care

AIM: To map the literature on tracheostomy and home invasive ventilation in infants and children with severe bronchopulmonary dysplasia (BPD), including indications, timing, respiratory outcomes, comorbidities, complications, growth, neurodevelopment, social determinants and transitional care. METHODS: We searched PubMed/MEDLINE, Embase, Scopus, Web of Science and CINAHL/EBSCO from inception to 30 June 2026. Search terms combined BPD or chronic lung disease of prematurity with tracheostomy or tracheotomy. Eligible studies included infants or children with BPD who underwent tracheostomy, received chronic invasive ventilation or were discharged on home mechanical ventilation. Conference abstracts without full-text articles, duplicate precursor abstracts, reviews and editorials were excluded from primary synthesis. RESULTS: Forty-one studies were included. Evidence was mainly retrospective, including cohorts, administrative database studies, multicentre registries and single-centre observational studies. Tracheostomy was generally considered for persistent invasive ventilation, failed extubation, high respiratory support needs, pulmonary hypertension, airway malacia, growth failure, sedation burden or limited developmental progress. Timing varied widely across centres. Pulmonary hypertension was associated with illness severity and mortality risk, although many children receiving home ventilation improved over time. Among survivors, ventilator liberation and decannulation were common but often occurred over several years. Airway complications, readmissions and operative airway interventions were frequent. Evidence also highlighted centre-level variation, racial and social disparities and limited caregiver-centred data. CONCLUSIONS: Tracheostomy and home invasive ventilation in severe BPD represent a prolonged care trajectory. Future work should define consensus indications, optimise timing, standardise transitional care and prioritise family-centred and equity-focused outcomes.