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Increased Mean Airway Pressure Is Associated With Successful Transition to a Portable Home Ventilator in Patients
Robin L McKinney1, Joseph M Collaco2, Amit Agarwal3,4
1Department of Pediatrics, Division of Critical Care Medicine, The Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA.
Insights
Higher portable home ventilator (PHV) pressures may help infants with severe bronchopulmonary dysplasia (BPD) transition from intensive care unit (ICU) ventilators. This finding is crucial for successful home discharge and avoiding prolonged ICU stays.
Area of Science:
- Neonatal Medicine
- Pediatric Pulmonology
- Respiratory Care
Background:
- Bronchopulmonary dysplasia (BPD) affects approximately 23% of children with grade 3 BPD, necessitating tracheostomy for long-term positive pressure ventilation.
- Transitioning from intensive care unit (ICU) ventilators to portable home ventilators (PHVs) is a critical step for patient discharge.
Purpose of the Study:
- To identify clinical factors and ventilator settings associated with successful PHV transition in infants with grade 3 BPD.
- To optimize the discharge process for ventilator-dependent infants.
Main Methods:
- Retrospective record review of 74 ventilator-dependent infants with grade 3 BPD across 15 centers.
- Hierarchical cluster analysis of patient demographics and ICU ventilator settings at the time of transition.
Main Results:
- Higher mean airway pressure (MAP) on PHV compared to ICU ventilators correlated with successful first-attempt transitions.
- Patients with higher PHV MAP experienced fewer days to successful transition and transitioned at an earlier postmenstrual age.
- ICU ventilator settings did not predict successful PHV transition.
Conclusions:
- Elevated PHV pressures may facilitate successful transition for severe BPD patients.
- Reducing ventilator pressures prematurely might prolong the need for ICU ventilation.
Objectives:
An estimated 23% of children with grade 3 bronchopulmonary dysplasia (BPD) require tracheostomy for long term positive pressure ventilation. Transition from an intensive care unit (ICU) ventilator to a portable home ventilator (PHV) is one of the key steps in the process of discharging a patient home. The objective of this study was to identify clinical factors and ventilator settings associated with successful transition to a PHV in infants with grade 3 BPD.
Study Design:
We performed a retrospective record review of 74 ventilator-dependent infants with grade 3 BPD hospitalized at 15 centers within the BPD Collaborative who transitioned to PHV between March 2021 and March 2023. Hierarchical cluster analysis of patient demographics and ICU ventilator settings at the time of transition was identify similar groups and compare factors associated with successful transitions.
Results:
Patients with higher mean airway pressure (MAP) on the PHV compared with the MAP on their ICU ventilator were more likely to successfully transition on the first attempt, had fewer days from their first attempt until successful transition, and transitioned at an earlier postmenstrual age than patients with a lower MAP on their PHV. Cluster analysis of baseline ICU ventilator settings did not predict successful transition to PHV.
Conclusions:
We conclude that higher PHV pressures may enable patients with severe BPD to transition to a PHV. Premature weaning of ventilator pressures may be associated with prolonged need for an ICU ventilator.
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