Inpatient Clinical Pathway for the Post-N/IICU Management of Infants with Severe Bronchopulmonary Dysplasia (BPD)

  • Review Criteria for Transfer from N/IICU
  • High flow nasal cannula flow of ≤ 4 LPM and ≤ 40% FiO2 for at least 24 hr with stable respiratory status and appropriate growth
  • No significant bradycardia/desaturation events requiring intervention
  • Pulmonary hypertension stable on enteral meds
  • No imminent neurosurgical interventions planned
  • Limited changes to the care plan for 24-48 hr prior to expected transfer
  • Consult
    • Pulmonary BPD Team
    • Complex Care Blue Team
  • Prepare family for transfer; consider family transition meeting
  • Initiate bed request for Complex Care Blue when bed available
  • N/IICU hand-off to Complex Care

Transfer to Complex Care Blue Team

  • Assess Readiness to Wean Weekly
    • Review:
      • Trends in O2 saturations, FiO2 needs, RR, resting HR
      • All growth parameters
      • Ability to tolerate and progress with therapies
      • Recommendations from BPD team

Wean Respiratory Support When Clinically Appropriate

Step LPM  
1 4 HFNC with Blended O2
2 3
3 2 FiO2 100%
Delivery via NC from oxygen source provides lower effective FiO2 than 100%
4 1
5 0.5
6 RA
0.25 LPM (FiO2 100%) may be an intermediate step prior to RA depending on patient condition and discussion with BPD team
Successful Wean to Discharge Level of Respiratory Support
RA preferred; may consider ≤ 0.5 LPM in discussion with BPD team
  • Monitor tolerance
  • Observe patient for minimum of 3 days
Posted: April 2022
Revised: May 2022
Authors: M. Dunn, MD; P. Mazzeo MD; K. Gibbs, MD; K. Mckenna, MD; A. Hogan, MD; D. Tauber, MD; J. Fierro, MD; J. Welc, SLP; K. Nilan, RN; C. Ehritz, RN; E. Becker, RN; L. Soorikian, RT