Preterm neonates were initially managed with either nCPAP or PS with rapid extubation to nCPAP had similar clinical outcomes to those treated with PS followed by a period of mechanical ventilation. An approach that uses early nCPAP leads to a reduction in the number of infants who are intubated and given surfactant.
Inadequate gas conditioning during non-invasive ventilation (NIV) can impair the anatomy and function of nasal mucosa. The resulting symptoms may have a negative effect on patients' adherence to ventilatory treatment, especially for chronic use. Several parameters, mostly technical aspects of NIV, contribute to inefficient gas conditioning. Factors affecting airway humidity during NIV include inspiratory flow, inspiratory oxygen fraction, leaks, type of ventilator, interface used to deliver NIV, temperature and pressure of inhaled gas, and type of humidifier. The correct application of a humidification system may avoid the effects of NIV-induced drying of the airway. This brief review analyses the consequences of airway dryness in patients receiving NIV and the technical tools necessary to guarantee adequate gas conditioning during ventilatory treatment. Open questions remain about the timing of gas conditioning for acute or chronic settings, the choice and type of humidification device, the interaction between the humidifier and the underlying disease, and the effects of individual humidification systems on delivered humidity.
Humidified high-flow nasal cannula (HHFNC) therapy for neonates has become increasingly popular in recent years. It is frequently used in circumstances when continuous positive airway pressure (CPAP) might otherwise have been used. Limited evidence is available to support the specific role, efficacy, and safety of HHFNC in newborns. This evidence suggests that HHFNC provides inconsistent and relatively unpredictable positive airway pressure, but may be effective in the treatment of some neonatal respiratory conditions while being more user-friendly for caregivers than conventional CPAP. Concerns regarding infection risks have resulted in one major HHFNC device being withdrawn from the market before being recently reintroduced. Caution should be exercised in the use of HHFNC in neonates (eg, by limiting its use to relatively lower flows and to relatively larger neonates, while collecting and closely monitoring safety and efficacy data) until further evidence is available to clearly delineate its role, as well as to support its safety and efficacy.
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