https://www.selleckchem.com/products/Semagacestat(LY450139).html Cascades of care are common and can lead to significant harms for patients, clinicians, and the health care system at large. In this commentary, we argue that there are 2 ways to reduce cascades decrease the use of unnecessary services that often initiate cascades (ie, close the floodgates) and mitigate cascades once they begin (ie, slow the flow through the floodgates). So far, most efforts to address cascades have focused on identifying, measuring, and educating clinicians on low-value services, with only modest success. We explore potential solutions for both closing the floodgates and slowing a cascade once the floodgates have been opened, including information to assist patients and clinicians in making better decisions, relationships that enable shared decision-making, and policy changes. Ultimately, reducing cascades while maintaining our commitment to high-quality care requires equipping patients and clinicians with the information, tools, and support needed to embrace uncertainty. The decision for tracheostomy for bronchopulmonary dysplasia (BPD) is highly variable and often dictated by local practice. We aimed to characterize morbidity, mortality, and respiratory outcomes in preterm infants undergoing tracheostomy for severe BPD. We retrospectively reviewed a single-center 4-year cohort of all infants born <33 weeks gestational age (GA) that required tracheostomy due to severe BPD. Indications for tracheostomy apart from BPD were excluded. Demographic information, comorbidities, respiratory management, age at tracheostomy, post-discharge respiratory outcomes, and survival were examined up to at least 5 years of age. At a mean corrected GA of 43.3 weeks, 49 preterm infants with severe BPD required tracheostomy. Forty-six infants (94%) had long-term follow-up. Compared to survivors, the 12 (26.1%) infants that died were significantly more likely to be small for gestational age (SGA) or require