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Management of Ventilator Support in Severe Bronchopulmonary Dysplasia

Hannah Giunta-Stibb1, Kala M Levine2, Gozdem Kayki3

  • 1Department of Pediatrics, Comprehensive Center for Bronchopulmonary Dysplasia, Nationwide Children's Hospital, 611 E Livingston Avenue (FOB), Columbus, OH 43205, USA; Division of Neonatology, Department of Pediatrics, The Ohio State University College of Medicine, Columbus, OH, USA; Division of Pulmonology, Department of Pediatrics, The Ohio State University College of Medicine, Columbus, OH, USA.

Clinics in Perinatology
|June 11, 2026
PubMed

Insights

This review details mechanical ventilation for infants with severe bronchopulmonary dysplasia (sBPD). It focuses on transitioning to chronic-phase ventilation using high peak inspiratory pressure and slow rates to support infant growth and neurodevelopment.

Area of Science:

  • Neonatology
  • Pediatric Pulmonology
  • Mechanical Ventilation

Background:

  • Severe bronchopulmonary dysplasia (sBPD) presents unique obstructive physiology.
  • Management requires tailored mechanical ventilation strategies.
  • Understanding "new" BPD pathophysiology is crucial for chronic-phase care.

Purpose of the Study:

  • To review mechanical ventilation strategies for infants with sBPD.
  • To emphasize the transition from acute to chronic ventilation.
  • To guide respiratory management based on sBPD pathophysiology.

Main Methods:

  • Review of mechanical ventilation principles for sBPD.
  • Description of obstructive physiology in sBPD.
  • Outline of practical ventilator approaches and monitoring.

Main Results:

  • Chronic-phase ventilation principles include high peak inspiratory pressure, slow rates, long inspiratory times, and adequate PEEP.
  • These strategies promote stability, growth, and neurodevelopment in infants with sBPD.
  • Individualized, physiology-based care is supported by practical approaches and monitoring.

Conclusions:

  • Mechanical ventilation for sBPD requires a shift towards chronic-phase strategies.
  • Optimized ventilation supports improved outcomes, including growth and neurodevelopment.
  • Experience from specialized centers informs individualized patient care.

Keywords:
Bronchopulmonary dysplasiaChronic ventilationMechanical ventilationSevere BPD

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