A specialised ventilation approach for managing infants with evolving or established BPD

Because these patients have **heterogeneous lungs** containing both compliant and stiff regions, traditional high-rate ventilation often causes uneven gas distribution and poor outcomes. To correct this, the HiT protocol utilizes **longer inspiratory times**, **higher tidal volumes**, and **lower ventilation rates** delivered via synchronized intermittent mandatory ventilation (SIMV). This method successfully recruits collapsed lung areas, clears carbon dioxide, and improves oxygenation while mitigating dangerous **air-trapping**. Furthermore, the guidelines detail specific **patient selection criteria**, recommended clinical settings, **recruitment maneuvers**, and **weaning protocols** designed to safely guide these vulnerable infants toward successful extubation.