Comparison of Interfaces for the Delivery of Noninvasive Respiratory Support to Low Birthweight Infants

Drescher, Gail; Hughes, Cathy

doi:10.4187/respcare.05978

Cited by 18 publications

(27 citation statements)

References 35 publications

(51 reference statements)

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“…21 While the use of RAM cannula for nasal CPAP has proven to be feasible, a growing body of evidence demonstrates suboptimal efficacy in pressure delivery. 7,18,19 Drescher and Hughes examined the implementation of the RAM cannula as an interface for CPAP and found significantly higher CPAP failure rates compared with historical controls given CPAP via SBP. 19 Recent evaluation of pharyngeal pressures with the RAM cannula demonstrated a decrease in the pressure of up to 2.45 cmH 2 O compared with an increase of 0.40 cmH 2 O with the SBP prongs.…”

Section: Discussionmentioning

confidence: 99%

“…7,18,19 Drescher and Hughes examined the implementation of the RAM cannula as an interface for CPAP and found significantly higher CPAP failure rates compared with historical controls given CPAP via SBP. 19 Recent evaluation of pharyngeal pressures with the RAM cannula demonstrated a decrease in the pressure of up to 2.45 cmH 2 O compared with an increase of 0.40 cmH 2 O with the SBP prongs. 17 The increases in the transmission pressures with the larger RAM cannulas (newborn and infant) in our in vitro studies are consistent with the decreasing resistance in the RAM tubing found on their FDA-approved data (www.…”

Section: Discussionmentioning

confidence: 99%

“…The in vitro modeling was done without a complicated test lung, but the findings are consistent with other research groups. [16][17][18][19]…”

Section: Discussionmentioning

confidence: 99%

“…7,14,16,17 Similar decreases in pressure transmission have also been seen with the use of the RAM cannula for noninvasive mechanical ventilation. 18,19 If the RAM cannula is employed in the DR for CPAP and in the early management of respiratory distress syndrome (RDS), increased set pressures may be required to provide adequate intra-alveolar pressures to maintain adequate FRC and avoid early endotracheal intubation. Using retrospective electronic medical record (EMR) data extraction from the DR and the first week of life, we compared average bCPAP pressures in the DR and the NICU over a 6-year period of RAM cannula use with CPAP failure rates.…”

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confidence: 99%

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Use of the RAM Cannula with Early Bubble Continuous Positive Airway Pressure Requires Higher Pressures: Clinical and In vitro Evaluations

et al. 2020

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Objective Early bubble continuous positive airway pressure (bCPAP) in the delivery room (DR) reduces early intubation, mechanical ventilation, and bronchopulmonary dysplasia. The RAM cannula, adopted for ease of patient care, is a high resistance nasal interface that, when used with bCPAP, only transmits a portion of set pressures and attenuates the bubble effects. This study aimed to review early bCPAP pressures and bCPAP failure with the RAM cannula interface over a 6-year period. Study Design Retrospective, single-center study of infants delivered <1,250 g from 2013 to 2018 (n = 735) begun on bCPAP in the DR with the RAM cannula. In vitro testing of bCPAP pressure transmission was also performed for multiple nasal interfaces and nasal occlusion percentages. Results The percentage of infants intubated in the DR decreased over time (59 to 42%), while the average bCPAP pressure increased from 5.3 to 6.8 cmH2O. A total of 355 infants (48%) were admitted to the neonatal intensive care unit (NICU) from the DR on BCPAP. The failure rate for bCPAP in NICU within 72 hours decreased from 45 to 24% as the maximum CPAP increased from 5.8 to 7.6 cmH2O. Pneumothorax rates did not change. CPAP pressure transmission decreased with all sizes of the RAM cannula. Conclusion When utilizing the RAM cannula for bCPAP, higher CPAP levels were associated with decreases in DR intubations and CPAP failure within the first 72 hours. If clinicians choose to use the RAM cannula for bCPAP, they will need higher set pressures to achieve lung inflation and the beneficial oscillatory effect will be diminished. Key Points

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

“…The in vitro modeling was done without a complicated test lung, but the findings are consistent with other research groups. [16][17][18][19]…”

Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

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Use of the RAM Cannula with Early Bubble Continuous Positive Airway Pressure Requires Higher Pressures: Clinical and In vitro Evaluations

et al. 2020

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“…Despite these higher pressures, however, the authors did not find higher rates of bronchopulmonary dysplasia, in fact, they noted a trend toward lower rates of bronchopulmonary dysplasia and significantly fewer days that required respiratory support. 1 This may indicate that they were able to safely overcome leaks and the resistance of the RAM cannula with the use of higher set pressures; however, this must always be done with extreme caution to avoid lung injury because reports are conflicting regarding pressure transmission via the RAM cannula.…”

mentioning

confidence: 99%

Noninvasive Respiratory Support for the Premature Infant: Choosing the Optimum Interface

Hoffman

2018

Respir Care

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Cannula With Long and Narrow Tubing vs Short Binasal Prongs for Noninvasive Ventilation in Preterm Infants

et al. 2021

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with long and narrow tubing (CLNT) has gained increasing popularity for applying noninvasive respiratory support for newborn infants thanks to ease of use, perceived patient comfort, and reduced nasal trauma. However, there is concern that this interface delivers reduced and suboptimal support. OBJECTIVE To determine whether CLNT is noninferior to short binasal prongs and masks (SPM) when providing nasal intermittent positive pressure ventilation (NIPPV) in preterm infants.DESIGN, SETTING, AND PARTICIPANTS This randomized controlled, unblinded, prospective noninferiority trial was conducted between December 2017 and December 2019 at 2 tertiary neonatal intensive care units. Preterm infants born between 24 weeks' and 33 weeks and 6 days' gestation were eligible if presented with respiratory distress syndrome with the need for noninvasive ventilatory support either as initial treatment after birth or after first extubation. Analysis was performed by intention to treat.INTERVENTIONS Randomization to NIPPV with either CLNT or SPM interface. MAIN OUTCOMES AND MEASURESThe primary outcome was the need for intubation within 72 hours after NIPPV treatment began. Noninferiority margin was defined as 15% or less absolute difference. RESULTSOverall, 166 infants were included in this analysis, and infant characteristics and clinical condition (including fraction of inspired oxygen, PCO 2 , and pH level) were comparable at recruitment in the CLNT group (n = 83) and SPM group (n = 83). The mean (SD) gestational age was 29.3 (2.2) weeks vs 29.2 (2.5) weeks, and the mean (SD) birth weight was 1237 (414) g vs 1254 (448) g in the CLNT and SPM groups, respectively. Intubation within 72 hours occurred in 12 of 83 infants (14%) in the CLNT group and in 15 of 83 infants (18%) in the SPM group (risk difference, −3.6%; 95% CI, −14.8 to 7.6 [within the noninferiority margin], χ 2 P = .53). Moderate to severe nasal trauma was significantly less common in the CLNT group compared with the SPM group (4 [5%] vs 14 [17%]; P = .01). There were no differences in other adverse events or in the course during hospitalization.CONCLUSIONS AND RELEVANCE In this study, CLNT was noninferior to SPM in providing NIPPV for preterm infants, while causing significantly less nasal trauma.

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Comparison of Interfaces for the Delivery of Noninvasive Respiratory Support to Low Birthweight Infants

Cited by 18 publications

References 35 publications

Use of the RAM Cannula with Early Bubble Continuous Positive Airway Pressure Requires Higher Pressures: Clinical and In vitro Evaluations

Use of the RAM Cannula with Early Bubble Continuous Positive Airway Pressure Requires Higher Pressures: Clinical and In vitro Evaluations

Noninvasive Respiratory Support for the Premature Infant: Choosing the Optimum Interface

Cannula With Long and Narrow Tubing vs Short Binasal Prongs for Noninvasive Ventilation in Preterm Infants

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