Prolonged Mechanical Ventilation in Children Born with Prematurity

Advances in neonatal intensive care have enabled the survival of extremely preterm infants. The emergence of a new form of bronchopulmonary dysplasia (BPD) is the result of alveolar and microvascular growth arrest in the lungs, and postnatal injury due to ventilatory support and oxygen therapy. Most severe forms of BPD may require prolonged mechanical ventilation (PMV) after birth or during the first 2 years of life. Different parenchymal, interstitial, and congestive lung phenotypes have been described, as well as different patterns of airway disorders and pulmonary hypertension in patients with severe BPD. Lung-protective strategies should be applied during the acute disease. But in patients with PMV, ventilatory strategies should be adjusted to the variations in compliance and resistance generated by the different phenotypes of BPD, with targets adapted to chronic ventilatory strategies. Pulmonary growth will allow a progressive reduction of ventilatory settings, with attention to the impact on infant growth and development. During weaning, noninvasive support, tracheostomy with progressive periods of spontaneous breathing, and home ventilatory support are alternatives to be considered, based on patient assessments and available resources.