Bronchopulmonary dysplasia (BPD) is the chronic lung disease of prematurity, and is the most common morbidity associated with preterm birth. Severe BPD is defined currently as a supplemental oxygen requirement at 28 days of age and a need for >30% oxygen and/or positive pressure at 36 weeks of corrected gestational age (CGA) in an infant born at <32 weeks of gestational age. The vast majority of severe BPD is characterized by high lung resistance, such that ventilation approaches must consider the relatively long time constants needed to adequately ventilate all portions of the lung to maximize ventilation-perfusion (V/Q) matching. At the same time, any ventilation strategy must take into account the vulnerable neurodevelopmental stage that characterizes the preterm infant with severe BPD. To maximize neurodevelopmental outcomes the ventilation strategy must avoid chronic use of sedation. In this chapter, we present the physiology underlying a low-rate, high-volume ventilation approach that maximizes V/Q matching, while optimizing neurodevelopment in patients with severe BPD.
Part of the book: Respiratory Management of Newborns