Respiratory support strategies in the prevention and treatment of bronchopulmonary dysplasia

Abstract

Neonates who are born preterm frequently have inadequate lung development to support independent breathing and will need respiratory support. The underdeveloped lung is also particularly susceptible to lung injury, especially during the first weeks of life. Consequently, respiratory support strategies in the early stages of premature lung disease focus on minimizing alveolar damage. As infants grow and lung disease progresses, it becomes necessary to shift respiratory support to a strategy targeting the often severe pulmonary heterogeneity and obstructive respiratory physiology. With appropriate management, time, and growth, even those children with the most extreme prematurity and severe lung disease can be expected to wean from respiratory support.

Respiratory Support Effects over Time on Regional Lung Ventilation Assessed by Electrical Impedance Tomography in Premature Infants

“…Avoiding intubation is one of the practice strategies aimed at bronchopulmonary dysplasia (BPD) prevention. Despite technical and knowledge advancements, even “gentle” invasive ventilation remains associated with significant risks of barotrauma, volutrauma, and atelectasis [ 8 , 9 ]. Therefore, early implementation of non-invasive respiratory support is recommended to mitigate the risk of lung injury and BPD [ 10 ].…”

Prevalence, Prevention and Management of Bronchopulmonary Dysplasia

“…Most often, infants with established BPD need large target volumes with long inspiratory times and a low rate. Larger targeted volumes (8-15 mL/kg) 272 delivered with a long inspiratory time (0.5-1 sec) 266 should help overcome the increased alveolar dead space and airway resistance in the slow compartment. Likewise, the low respiratory rate (12-20 bpm) allows for the increased emptying time present in these slow compartments; an I:E ratio of 1:5 is preferable.…”

“…Likewise, the low respiratory rate (12-20 bpm) allows for the increased emptying time present in these slow compartments; an I:E ratio of 1:5 is preferable. 272 The amount of PEEP (7-12 cmH 2 O) required will also vary based on disease phenotype. If an infant appears to have a significant component of airway malacia, higher PEEPs are often necessary.…”