Ventilation settings in preterm neonates with ventilator-dependant, evolving bronchopulmonary dysplasia

Area of Science:

• Neonatal Medicine
• Pediatric Pulmonology
• Critical Care

Background:

• Current literature lacks validated guidance on tidal volumes for infants with or at risk of bronchopulmonary dysplasia (BPD).
• Existing recommendations suggest high tidal volumes (8-12 mL/kg) and low rates, but without supporting data.
• This study investigated actual mechanical ventilation practices in ventilator-dependent neonates with evolving BPD.

Purpose of the Study:

• To identify current mechanical ventilation settings used in neonates with ventilator-dependent evolving BPD.
• To determine the carbon dioxide (CO2) levels achieved with these settings.
• To compare actual clinical practice with existing, unvalidated recommendations.

Main Methods:

• Retrospective observational cohort study.
• Inclusion of neonates born <30 weeks gestational age with evolving BPD, ventilated on days 28, 42, and 56 of life.
• Analysis of mechanical ventilation parameters including tidal volume, respiratory rate, and mean airway pressure (MAP).

Main Results:

• 105 neonates (23-28.5 weeks GA) were included.
• Conventional mechanical ventilation (CMV) used median tidal volumes of 4.5-4.7 mL/kg, rates of 35-50, and MAPs of 10-11 cmH2O.
• High-frequency oscillatory ventilation (HFOV) used median tidal volumes of 1.4-2.2 mL/kg and MAPs of 14-18 cmH2O.

Conclusions:

• Neonates with ventilator-dependent evolving BPD were ventilated with lower tidal volumes than previously suggested (CMV: 4-5 mL/kg; HFOV: 1-2 mL/kg).
• These settings achieved adequate ventilation and blood gas results.
• Clinical practice deviates from historical recommendations, suggesting a need for updated guidelines based on current data.