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Classifying multicenter approaches to invasive mechanical ventilation for infants with bronchopulmonary dysplasia

Matthew J Kielt1, L Dupree Hatch2, Jonathan C Levin3

  • 1Division of Neonatology, Department of Pediatrics, Nationwide Children's Hospital and The Ohio State University College of Medicine, Columbus, Ohio, USA.

Pediatric Pulmonology
|June 2, 2023
PubMed

Insights

Ventilator settings in infants with severe bronchopulmonary dysplasia (BPD) were analyzed, revealing three distinct ventilation strategies. Further research is needed to link these strategies to clinical outcomes.

Area of Science:

  • Neonatal Medicine
  • Pediatric Respiratory Medicine
  • Critical Care Medicine

Background:

  • Evidence-based ventilation strategies for severe bronchopulmonary dysplasia (BPD) are not well-defined.
  • Contemporary ventilation approaches may represent distinct BPD care strategies.
  • Characterizing these strategies can improve clinical trial design for BPD.

Purpose of the Study:

  • To test if unsupervised clustering of ventilator settings identifies distinct physiological approaches in infants with severe BPD.
  • To analyze ventilator data from a multicenter cohort of infants with severe BPD.

Main Methods:

  • Secondary analysis of a multicenter point prevalence study.
  • Invasive mechanical ventilation data from infants with severe BPD were used.
  • Ward's hierarchical clustering analysis (HCA) was applied to mean airway pressure (MAP), positive end-expiratory pressure (PEEP), respiratory rate, and inspiratory time (Ti).

Main Results:

  • Seventy-eight infants with severe BPD from 14 centers were included.
  • HCA identified three discrete clusters with strong stability.
  • Significant differences in PEEP, MAP, rate, Ti, and peak inspiratory pressure (PIP) were observed between clusters (p < 0.0001).

Conclusions:

  • Unsupervised clustering of ventilator settings identified three distinct mechanical ventilation approaches in infants with severe BPD.
  • Prospective trials are necessary to determine associations with BPD phenotypes.
  • Further investigation is needed to assess differential effects on respiratory outcomes.
Abstract

Keywords:
chronic lung diseaseneonatologypulmonologytracheostomy

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