Management of Premature Infants in Neonatal Intensive Care Unit (NICU) with Severe Chronic Lung Disease of Infancy Requiring Discharge on Chronic Home Ventilation - A National Survey Rajeev Bhatia, MD, John McBride, MD Robert T. Stone Respiratory Center, Akron Children’s Hospital, Akron, Ohio, USA AbstractResults Conclusions Management of Premature Infants in Neonatal Intensive Care Unit (NICU) with Severe Chronic Lung Disease of Infancy Requiring Discharge on Chronic Home Ventilation - A National Survey Introduction- The incidence of premature infants with severe chronic lung disease of infancy necessitating home mechanical ventilation is increasing. However, there is no consensus about the management of home mechanical ventilation in these premature infants in neonatal intensive care unit (NICU). In this study, we aim to assess the discrepancy or commonality among different big pediatric centers across the United States in managing these patients in NICU. Methods- A survey encompassing 34 questions was designed by authors with the help of NICU- Pulmonary home ventilator task force at Akron Children’s Hospital which included pulmonologists, neonatologists, respiratory therapists, NICU nurses and case managers. This survey was sent to 31 pediatric centers across the U.S via SurveyMonkey. The responses were compiled and reviewed. Results: There were 19 (16 pediatric pulmonologists, 1 pediatric intensivist and 2 respiratory therapist) respondents from 17 centers across the U.S. 14 out of 19 respondents mentioned uncuffed tracheostomy as the preferred choice for artificial airway. LTV series (47.8 %) ventilators were the most common home ventilators used among the centers. The physician’s and medical equipment company’s familiarity with the ventilator and its availability were more important factors in considering particular home ventilator vs. technical characteristics of the ventilator. The pressure control mode was preferred mode by big margin in comparison to volume control (52.63% vs %) (Figure 1). SIMV + PS was the preferred pressure control mode. 8 cm H 2 O was maximum allowable PEEP at the time of discharge at most of the centers (68.42%). Maximum allowable FiO 2 of 35-40% at the time of discharge with goal hemoglobin saturation of > or equal to 92% in patients without pulmonary hypertension (> or equal 95% for patients with pulmonary hypertension) was the most common answer in context of oxygen therapy. In % of responses, the neonatologist was the attending at the time of discharge in comparison to 31.3 % where the pediatric pulmonologist was the attending in charge. Stability for 2 weeks prior to discharge was the most acceptable criteria (42.1%) prior to discharge at most of the centers. The combination of gradual decrease in ventilator settings and windows off ventilator was the most acceptable strategy among all the centers for weaning ventilator as outpatient. Conclusion- Most centers agreed on some basic principles; however there were still a lot of discrepancies among different centers in managing these patients. There is urgent need for formal management guidelines in this rapidly growing field.. Introduction Acknowledgements  Incidence of premature infants with severe chronic lung disease of infancy necessitating home mechanical ventilation is increasing.  There is no consensus about the management of home mechanical ventilation in these premature infants in neonatal intensive care unit (NICU).  19 (16 pediatric pulmonologists, 1 pediatric intensivist and 2 respiratory therapists) respondents from 17 centers across the U.S.  14 out of 19 respondents mentioned uncuffed tracheostomy as the preferred choice for artificial airway.  LTV series (48%) ventilators were the most common home ventilators used among the centers.  The physician’s and medical equipment company’s familiarity with the ventilator and its availability were more important factors in considering particular home ventilator vs. technical characteristics of the ventilator.  The pressure control mode was preferred mode by big margin in comparison to volume control (Figure 1). SIMV + PS was the preferred pressure control mode.  8 cm H 2 O was maximum allowable PEEP at the time of discharge at most of the centers (68%). (Figure 2)  Maximum allowable FiO 2 of 35-40% at the time of discharge (Figure 3) with goal hemoglobin saturation of > 92% in patients without pulmonary hypertension (> 95% for patients with pulmonary hypertension) was the most common answer in context of oxygen therapy.  In 56 % of responses, the neonatologist was the attending at the time of discharge in comparison to 31 % where the pediatric pulmonologist was the attending in charge.  Stability for 2 weeks prior to discharge was the most acceptable criterion (42%) for discharge. (Figure 4)  Minimum amount of home nursing coverage required prior to discharge – 8 hours was the most common answer followed by 12 hours. (Figure 5) Insert your text here  William Van Nostran, BS for technical assistance  All the pediatric centers who took part in this survey and provided invaluable input Aim  To assess the discrepancy or commonality among pediatric centers across the United States in managing these patients in NICU Methods  Survey encompassing 34 questions was sent to 31 pediatric centers across the U.S via Survey Monkey.  Survey was designed by authors with the help of NICU- Pulmonary home ventilator task force at Akron Children’s Hospital which included pulmonologists, neonatologists, respiratory therapists, NICU nurses and case managers.  Most centers agreed on some basic principles; however there were still many discrepancies among centers in managing these patients.  There is urgent need for formal management guidelines in this rapidly growing field. Figure 1 Figure 2 Figure 3 Figure 4 Figure 5 53% 68% 42%