Adaptation of ventilation strategies from acute RDS to severe BPD: A national multicenter survey of practices in extremely preterm infants

Abstract

Advances in diagnostic and therapeutic methods have led to a paradigm shift in the management of bronchopulmonary dysplasia (BPD). The lack of evidence-based data in this area has led to variations in clinical practice. The aim of this study was to identify these differences and compare them with recommendations based on pathophysiology. The study was designed as an observational online survey of neonatologists from level 3 to 4 neonatal intensive care units caring for premature infants at increased risk of BPD and born before 28 weeks' gestation. Respondents were invited to participate in the study through the portal of the Turkish Neonatal Society. Participants were surveyed online about preferred ventilation modes, settings and clinical management of these patients through each respiratory distress syndrome, evolving BPD and severe BPD phases. A total of 39 centers involved in the study. Pressure-control assist-control volume-guaranteed was the most commonly preferred ventilation mode in respiratory distress syndrome and evolving BPD, while high frequency oscillatory ventilation was most commonly used in severe BPD. The use of synchronized intermittent mandatory ventilation volume-guaranteed pressure support ventilation increased with disease progression. Ventilation settings were found to be changed according to pathophysiological recommendations, but not to the extent recommended. The study shows that early ventilation strategies are predominantly maintained in the later phases of BPD, although there are notable differences between centers.