B105-20 Home Ventilation Transition and Liberation in Severe BPD: Consensus Recommendations From a Delphi Process

Abstract Background The most common indication for tracheostomy in infants is prolonged mechanical ventilation due to severe bronchopulmonary dysplasia (BPD). Although tracheostomy enables life-sustaining long-term respiratory support, clinical practices related to chronic invasive ventilation differ substantially across centers. Currently, no standardized framework exists to guide hospital-to-home transition, outpatient weaning strategies, or longitudinal ventilatory management for this high-risk population. As a result, care is often fragmented, outcomes vary widely, and families and care teams face a significant burden. This study seeks to systematically develop expert consensus to define best practices for managing infants with severe BPD who require chronic home mechanical ventilation, with the goal of improving care coordination, standardizing clinical decision-making, and optimizing long-term outcomes. Methods We conducted an iterative Delphi survey among BPD Collaborative members with expertise in managing chronic ventilation in severe BPD, including neonatologists, pediatric intensivists, pulmonologists, advanced practice nurses, nurses, and respiratory therapists. Questionnaires presented a case vignette of an infant with severe BPD and tracheostomy/ventilator dependence across three stages: hospital-to-home transition, outpatient weaning, and decannulation. Qualitative analyses ranked responses, which were redistributed in subsequent rounds. Consensus was defined a priori as ≥ 80% participant agreement. Results Thirty-one experts from 19 centers completed all three rounds of the Delphi survey, achieving a 91% participation rate and 100% response completion across all rounds.(Figure-1) Consensus was reached on several domains, including assessing readiness and monitoring during transition to a portable/home ventilator, discharge readiness and caregiver teaching, outpatient ventilator weaning and monitoring, oral feeding during ventilation, readiness for sprinting trials, liberation from mechanical ventilation, and decannulation criteria.(Table -1) However, no consensus emerged regarding the preferred ventilator circuit type for transition to a home ventilator, home nursing requirements prior to discharge, detailed ventilator or oxygen weaning strategies, acceptable CO2 thresholds, diuretic taperingprotocols, or the role of polysomnography and speaking valve use in weaning and decannulation decisions. Conclusion This Delphi study identified consensus-based best practices for managing tracheostomy-dependent children with severe bronchopulmonary dysplasia requiring chronic outpatient ventilation. Key areas of agreement included transition to home ventilators, discharge readiness, outpatient ventilation management (weaning and discontinuation), and decannulation. These recommendations provide practical guidance in the absence of empirical evidence but highlight the need for research to validate these practices and address gaps in home ventilator transition, discharge criteria, caregiver education, home nursing, telemedicine, feeding strategies, and liberation from ventilation. Future implementation studies are essential to assess the effectiveness of these consensus-based approaches. This abstract is funded by: None