Management of Severe BPD Requiring Chronic Medical Support

Shepherd, Edward G.; Malleske, Daniel T.; Lynch, Susan K.; Nelin, Leif D.

doi:10.1016/b978-0-323-68353-1.00018-x

Cited by 2 publications

(1 citation statement)

References 33 publications

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“…In infants with severe BPD requiring mechanical ventilation, the primary goals of care are to prevent infections, screen for and manage PH, optimize growth, neurodevelopmental outcomes, and provide minimal impact respiratory support. 28 Infants with established severe BPD and heterogenous lung disease require a change in ventilation strategy to a slower rate, higher iT, high TV, and adequate PEEP, which often requires careful titration if severe airway malacia is present. 16 Rapid ventilator weaning can result in atelectasis, worsening gas exchange, escalating FiO 2 requirements, and increased work of breathing.…”

Section: Inpatient Managementmentioning

confidence: 99%

ATS core curriculum 2023. Pediatric pulmonary medicine: Respiratory disorders in infants

Leon‐Astudillo,

Dy,

McCown

et al. 2024

Pediatric Pulmonology

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The American Thoracic Society Core Curriculum updates clinicians annually in pediatric pulmonary disease. This is a summary of the Pediatric Pulmonary Medicine Core Curriculum presented at the 2023 American Thoracic Society International Conference. The respiratory disorders of infancy discussed in this year's review include: the care of the patient with bronchopulmonary dysplasia in the neonatal intensive care unit, clinical phenotypes and comorbidities; diffuse lung disease; pulmonary hypertension; central and obstructive sleep apnea. The care of infants with respiratory disorders often poses significant challenges to the general pediatric pulmonologist, sleep clinician, and neonatologist. This review aims to highlight the most clinically relevant aspects of the evaluation, management, and outcomes of infants with these key respiratory disorders, while emphasizing the importance of multidisciplinary care. Furthermore, this document summarizes essential aspects of genetic testing, novel imaging and treatment modalities, and includes multiple resources for clinical practice.

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Section: Inpatient Managementmentioning

confidence: 99%

ATS core curriculum 2023. Pediatric pulmonary medicine: Respiratory disorders in infants

Leon‐Astudillo,

Dy,

McCown

et al. 2024

Pediatric Pulmonology

View full text Add to dashboard Cite

show abstract

Established severe BPD: is there a way out? Change of ventilatory paradigms

Collaborative

2021

Pediatr Res

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Improved survival of extremely preterm newborn infants has increased the number of infants at risk for developing bronchopulmonary dysplasia (BPD). Despite efforts to prevent BPD, many of these infants still develop severe BPD (sBPD) and require long-term invasive mechanical ventilation. The focus of research and clinical management has been on the prevention of BPD, which has had only modest success. On the other hand, research on the management of the established sBPD patient has received minimal attention even though this condition poses large economic and health problems with extensive morbidities and late mortality. Patients with sBPD, however, have been shown to respond to treatments focused not only on ventilatory strategies but also on multidisciplinary approaches where neurodevelopmental support, growth promoting strategies, and aggressive treatment of pulmonary hypertension improve their long-term outcomes. In this review we will try to present a physiology-based ventilatory strategy for established sBPD, emphasizing a possible paradigm shift from acute efforts to wean infants at all costs to a more chronic approach of stabilizing the infant. This chronic approach, herein referred to as chronic phase ventilation, aims at allowing active patient engagement, reducing air trapping, and improving ventilation-perfusion matching, while providing sufficient support to optimize late outcomes.

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Management of Severe BPD Requiring Chronic Medical Support

Cited by 2 publications

References 33 publications

ATS core curriculum 2023. Pediatric pulmonary medicine: Respiratory disorders in infants

ATS core curriculum 2023. Pediatric pulmonary medicine: Respiratory disorders in infants

Established severe BPD: is there a way out? Change of ventilatory paradigms

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