Abstract Rationale The transition to a portable ventilator remains understudied in preterm children with bronchopulmonary dysplasia (BPD) mechanically ventilated via tracheostomy. Although protocols and expert recommendations are available, the impact of the mode of ventilation on transition to a portable ventilator remains limited. Our institution has increasingly used volume-targeted pressure support (VT-PS) ventilation in this population. We aim to describe VT-PS use in children with BPD ventilated via tracheostomy. Methods A retrospective chart review was performed on children with BPD who underwent tracheostomy placement between January 1, 2015, and December 31, 2024. Children who underwent tracheostomy at ≥ 24 months of age or transitioned to a portable ventilator outside of Children’s Hospital Colorado (CHCO) were excluded. Descriptive statistics were performed based on ventilator mode and ventilator settings at the time of transition to a portable ventilator. A successful transition from an intensive care unit ventilator to a portable ventilator was defined as remaining on a portable ventilator for ≥14 days without a change in the mode of ventilation. Results Of the 126 preterm children with BPD who underwent tracheostomy and transitioned to a portable ventilator, 112 met the inclusion criteria. A majority of participants were male (67; 59.8%) with a median gestational age of 26 weeks (IQR 24 - 27) and median birth weight of 690g (IQR 580 - 898). The most frequently co-occurring diagnoses included airway malacia (59; 52.7%) and pulmonary hypertension (51; 45.5%). Among study participants, 223 attempted transitions to a portable ventilator were identified. When assessing transition to a portable ventilator, 24 trials were excluded due to a mode change 14 days after transition, and 1 had incomplete documentation. Most transitions were performed using VT-PS (124; 62.6%), followed by synchronized intermittent mandatory ventilation with volume control (SIMV-VC; 66; 33.3%), and 8 (4.0%) using other modes. There was no difference in successful transition to a portable ventilator between VT-PS and SIMV-VC (81 65.3% vs. 37 56.1%, p = 0.214). A higher tidal volume was associated with unsuccessful transition to a portable ventilator across all ventilator modes (Figure 1). No significant differences in PEEP, tidal volume, iTime, FiO2, or rate in were found between successful and unsuccessful trials for either VT-PS or SIMV-VC. Conclusions Our institution’s use of VT-PS has shown this modality can lead to a successful transition to a portable ventilator. VT-PS as the first mode chosen on a portable ventilator appeared non-inferior to SIMV-VC for infants with BPD. This abstract is funded by: None
Tilly-Gratton et al. (Fri,) studied this question.