A Physiology-Based Approach to the Respiratory Care of Children With Severe Bronchopulmonary Dysplasia

Classifying multicenter approaches to invasive mechanical ventilation for infants with bronchopulmonary dysplasia using hierarchical clustering analysis

“…The combination of increased airway resistance and variable dynamic compliance in different lung compartments likely results in variable time constants throughout the lung 27 . Providing optimal ventilation to regionally heterogeneous lung compartments with nonuniform filling and emptying is challenging and optimal ventilation strategies for ventilator‐dependent infants with BPD remain unknown 26,28,29 . Our study adds to the current literature by classifying three distinct mechanical ventilation strategies that can be utilized in the care of ventilator‐dependent infants with BPD to facilitate chronic ventilation in this heterogeneous population.…”

“…27 Providing optimal ventilation to regionally heterogeneous lung compartments with nonuniform filling and emptying is challenging and optimal ventilation strategies for ventilator-dependent infants with BPD remain unknown. 26,28,29 Our study adds to the current literature by classifying three distinct mechanical ventilation strategies that can be utilized in the care of ventilator-dependent infants with BPD to facilitate chronic ventilation in this heterogeneous population. More broadly, the novel methodology presented in our study demonstrates the potential for how unsupervised clustering analyses can be used to understand how prescribed ventilator settings interact to form distinct ventilation strategies that are plausibly generalizable within and between centers.…”

Adjusting ventilator settings to avoid air trapping in extremely premature infants reduces the need for tracheostomy and length of stay

“…Our interdisciplinary group utilizes a bedside ventilator assessment to guide changes in ventilator parameters to minimize autoPEEP while addressing restriction to inspiratory and expiratory flow with larger tidal volumes and slower respiratory rates. These strategies have been recommended by multiple experts in the field (34, 35).…”