Mechanical ventilation is ubiquitous to intensive care from the neonatal ICU to adult critical care. Our understanding of mechanical ventilation and the importance of lung protective approaches has grown steadily in the last two decades, yet clinicians often fail to use lung protective tidal volumes in about half of cases. This is particularly true in female patients. While closed loop control of the ventilator has been suggested, the regulatory pathway has been difficult. Decision assist — expert advice based on the evidence from a computerized system may provide a step towards improved safety at a lower regulatory requirement.

Following extubation, the need for reintubation is associated with prolonged hospital stay and significant morbidity and mortality. Post extubation support in pediatrics may include standard oxygen therapy, high flow nasal cannula, non-invasive ventilation or CPAP. Each modality has strengths and weaknesses. This presentation will review the evidence for escalating post-extubation respiratory support and define the optimum use of therapies to prevent re-intubation.

The Great Bronchiolitis Epidemic of 2022 taught all of us a lot. Between the surge plans, providing care in unconventional spaces, triage strategies, and teaching adult hospitals how to care for kids — we also learned more about the role of HFNC in treating infants with bronchiolitis. Due to the astronomical cost of bronchiolitis care in 2022, de-implementation of unindicated therapies and development of HFNC protocols utilizing holidays have been a large focus for our profession.

Respiratory therapists play a crucial role in the care and management of medically complex neonatal respiratory patients. When it comes to discharging graduates of the NICU home, RTs face unique ethical challenges. We will discuss the ethical challenges specifically encountered by RTs in the discharge process and explore strategies to address these challenges.

Practicing neonatal pediatric respiratory care is both an art and a science. Unfortunately, evidence to defend many common practices is lacking. This leaves the RT in the position of having to make clinical decisions using only experience and adult literature. This lecture will discuss strategies for the RT to employ when the answers are not obvious, and identify gaps in knowledge that need to be addressed in order to best serve this vulnerable patient population.

Pediatric ventilator-associated events are an undesired consequence of invasive mechanical ventilation. Though hospitals are required to track and report VAE rates, the question remains whether a reduction of risk impacts incidence of PedVAE. A review of the evidence will leave it to the audience to decide: Should Pediatric VAE be a hospital acquired harm indicator?

E-cigarette, or vaping, product use associated lung injury (also known as EVALI) is a rapidly evolving lung health issue more commonly seen in adolescents and young adults. Respiratory therapists remain at the forefront of this health crisis. This presentation will discuss the current evidence associated with EVALI cause, diagnosis, and treatment.