Measurement of intrinsic positive end-expiratory pressure and clinical outcomes of infants with severe bronchopulmonary dysplasia

Abstract:

Objective To investigate the levels of intrinsic positive end-expiratory pressure (PEEPi) in infants with severe bronchopulmonary dysplasia (sBPD) and the relationship between different levels of PEEPi and clinical outcomes.Methods A retrospective analysis was conducted on the clinical data of 12 sBPD infants who underwent PEEPi measurement and were hospitalized at Guangzhou Women and Children's Medical Center from January 2022 to June 2023. The clinical manifestations and outcomes at discharge were compared between infants with very high PEEPi (≥10 cmH₂O) and those with lower PEEPi (<10 cmH₂O).Results PEEPi measurements were taken in 12 sBPD infants between gestational age 31⁺³ and 67⁺² weeks postmenstrual age, with the lowest PEEPi measured at 0.9 cmH₂O and the highest at 19.6 cmH₂O; 50% (6/12) of the infants had PEEPi ≥10 cmH₂O. All infants with very high PEEPi exhibited ineffective triggering and patient-ventilator asynchrony. Among them, 5 infants could not be weaned off invasive ventilation, resulting in 4 deaths and 1 infant being discharged with a tracheostomy and ventilator support. In contrast, among the infants with PEEPi <10 cmH₂O, only 1 infant died, while the others were successfully extubated and discharged.Conclusions Infants with sBPD may have elevated PEEPi levels, and very high PEEPi may be associated with adverse outcomes in these patients.