B27-06 Accelerating Ventilator Weaning for Children With BPD and Long-term Ventilator Dependence: Outcomes of a Standardized Inpatient Weaning Approach

Abstract Rationale Children with severe bronchopulmonary dysplasia (BPD) requiring invasive long-term mechanical ventilation (LTMV) represent a growing population that places substantial demands on caregivers and the healthcare system. LTMV carries significant risks, including ventilator-associated lung injury and infection, tracheostomy-related complications, and increased morbidity and mortality, making timely and efficient liberation from the ventilator critical for optimizing outcomes and quality of life. Although most children can be weaned from ventilator support by ∼26 months of age, substantial variability exists and evidence to guide weaning remains limited. To standardize practice at our center (CCHMC), a nurse practitioner–led group developed a Vent Wean Protocol (VWP). The VWP emphasizes reassessment of weaning readiness every 3 days and provides structured guidance for ventilator adjustment (e.g., decrease PEEP by 1, peak inspiratory pressure (PIP) by 2, rate by 4) while preserving clinical judgment. This retrospective study evaluated the impact of the VWP on time from transition to the home ventilator device to the first 60-minute off-ventilator “window.” Methods Patients with BPD and tracheostomy requiring LTMV between 9/2016–9/2022 were identified. Exclusion criteria included significant genetic, neuromuscular, cardiac, or neurologic comorbidities. The study period spanned VWP implementation in 2/2019. Chart review provided data on ventilator parameters and time from transition to 60-minute window initiation. Outcomes and patient characteristics were compared pre- and post-VWP using univariate analyses. To minimize outpatient variability, a subgroup analysis was performed for patients achieving the 60-minute window during their initial inpatient stay. Time trends were visualized using a statistical process control chart. Results Forty-five patients met inclusion criteria (21 pre- and 24 post-VWP). Groups were comparable at transition in PEEP, PIP, FiO2, weight, and tracheostomy size; post-VWP patients had a slightly lower mandatory rate (22.8 vs. 18.8; p = 0.01). Use of bethanechol and sildenafil—surrogates for tracheobronchomalacia and pulmonary hypertension—was similar. At the 60-minute window, PEEP and FiO2 were modestly higher post-VWP. For the full cohort, time from transition to 60-minute window was unchanged; however, among inpatients achieving the milestone before discharge, median time decreased from 131 to 95 days (p = 0.099) (Figure). Conclusions Implementation of a standardized ventilator weaning protocol for children with severe BPD reduced time to initial 60-minute ventilator-free window by an average of 36 days among inpatients. Protocol-driven standardization may accelerate LTMV weaning and improve efficiency of care, though variability in outpatient management limits its broader impact. This abstract is funded by: None