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In infants with grade 3 bronchopulmonary dysplasia, higher mean airway pressure on portable home ventilators improves first-attempt transition success, shortens time to conversion, and enables earlier postmenstrual age discharge.
A new multicenter analysis from the bronchopulmonary dysplasia (BPD) Collaborative highlights the importance of ventilator strategy in infants with grade 3 BPD undergoing transition to portable home ventilators (PHV). Grade 3 BPD represents the most severe form of chronic lung disease in preterm infants, and nearly 23% of affected children require tracheostomy for long-term positive pressure ventilation.
In this retrospective record review, investigators evaluated 74 ventilator-dependent infants with grade 3 BPD treated across 15 centers. All patients underwent transition from an intensive care unit (ICU) ventilator to a PHV—an essential step toward hospital discharge and home-based respiratory support. Using hierarchical cluster assessment of patient demographics and ICU ventilator settings at the time of transition, researchers sought to identify clinical predictors of successful PHV conversion. Notably, baseline ICU ventilator parameters did not predict successful transition outcomes.
However, infants managed with greater mean airway pressure (MAP) on the portable home ventilator—as opposed to their ICU ventilator MAP—illustrated better outcomes. These patients were more likely to succeed on their first transition attempt, required fewer days from initial attempt to successful conversion, and transitioned at an earlier postmenstrual age.
Hence, maintaining or increasing MAP during PHV initiation may optimize respiratory stability in severe BPD. Conversely, premature weaning of ventilator pressures could prolong ICU dependence and delay discharge readiness. This study underscores the critical role of ventilator settings—particularly MAP—in facilitating safe and efficient transition to home ventilation in infants with severe BPD, potentially improving care pathways and minimizing prolonged ICU stays.
Pediatric Pulmonology
Increased Mean Airway Pressure Is Associated With Successful Transition to a Portable Home Ventilator in Patients With Grade 3 Bronchopulmonary Dysplasia
Robin L McKinney et al.
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