PEEP and Oxygen Requirements With Pressure Support vs Pressure Control for Bronchopulmonary Dysplasia in the Home

Abstract

Background:

The optimal method for home ventilation in bronchopulmonary dysplasia (BPD) is not well defined. These patients have heterogeneous lung disease with increased alveolar dead space and airway resistance, varying time constants, malacia, and hyperinflation. A BPD collaborative suggested that ventilation strategies using larger tidal volumes, slower rates, and longer inspiratory times (Ti) have been successful.

Methods:

Retrospective cohort study at a pediatric academic medical center including patients from 9/2016 to 2/2021 with a primary diagnosis of BPD and discharged with tracheostomy and home ventilation. PC or PS ventilation mode was chosen at the discretion of the ICU team. We sought to evaluate differences between allowing titrated PS (+/- volume guarantee) with varying rise time, % cycle time and Ti range vs PC with a set pressure, respiratory rate, and Ti. Data collected included gestational age (GA) at birth, birth weight (BW) and weight at time of trach (TW), respiratory support at 36-weeks postmenstrual age (PMA), PMA and respiratory support at time of trach and discharge, and days from trach to discharge. P-values were calculated using a 2-tailed unpaired t-test with a significance level of 5%.

Results:

Eighteen infants were included (PS n = 11, PC n = 7). There were no significant differences between the PS and PC groups for GA at birth, BW, support at 36-week PMA, age at trach, TW, FIO₂ at trach, or days from trach to discharge. Significant differences were found in FIO₂ at discharge (lower in PS group, P = 0.0002), PEEP at trach and discharge (lower in PS group, P = 0.019 and 0.003, respectively).

Conclusions:

PSV can be safely applied in BPD patients for home ventilation with a lower oxygen requirement at discharge than those on PCV. The PEEP in the PS group was also lower at the time of discharge, however they started with a significantly lower PEEP at the time of trach and both groups had an equivalent decrease in PEEP from time of trach to discharge of ∼1.5 cm H₂O. PSV does not change the time from trach to discharge and may provide oxygen cost savings in the hospital and home.